Provider Demographics
NPI:1528299500
Name:MANGUM GIBBONS, DONNA MARIE (PT)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:MARIE
Last Name:MANGUM GIBBONS
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 1:107 GREEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MD
Mailing Address - Zip Code:21012-2241
Mailing Address - Country:US
Mailing Address - Phone:443-883-5641
Mailing Address - Fax:
Practice Address - Street 1:7700 CHERRY LN
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-3603
Practice Address - Country:US
Practice Address - Phone:301-776-6777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-07
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16560225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist