Provider Demographics
NPI:1487787024
Name:SECRIST, DONNA B (PT)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:B
Last Name:SECRIST
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11514 CHICKAHOMINY BRANCH DR
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-5119
Mailing Address - Country:US
Mailing Address - Phone:804-262-5584
Mailing Address - Fax:
Practice Address - Street 1:13700 N GAYTON RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23233-7017
Practice Address - Country:US
Practice Address - Phone:804-364-6352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305003933225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist