Provider Demographics
NPI:1366720161
Name:PLINK, SALLY DONNA (LMT)
Entity type:Individual
Prefix:MRS
First Name:SALLY
Middle Name:DONNA
Last Name:PLINK
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MRS
Other - First Name:SALLY
Other - Middle Name:DONNA
Other - Last Name:PLINK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:10671 104TH AVE N
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33773
Mailing Address - Country:US
Mailing Address - Phone:727-459-4575
Mailing Address - Fax:727-286-6974
Practice Address - Street 1:10671 104TH AVE N
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33773
Practice Address - Country:US
Practice Address - Phone:727-459-4575
Practice Address - Fax:727-286-6974
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-27
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL56820225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist