Provider Demographics
NPI:1427258144
Name:PIEKUTOWSKI, DONNA R (PTA)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:R
Last Name:PIEKUTOWSKI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6801 DEER BLUFF DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45424-7036
Mailing Address - Country:US
Mailing Address - Phone:937-669-4480
Mailing Address - Fax:
Practice Address - Street 1:6801 DEER BLUFF DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45424-7036
Practice Address - Country:US
Practice Address - Phone:937-669-4480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03514225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant