Provider Demographics
NPI:1528500204
Name:FLOOD, DONNA GAIL (PTA AAS)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:GAIL
Last Name:FLOOD
Suffix:
Gender:F
Credentials:PTA AAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:368 W KING RD
Mailing Address - Street 2:
Mailing Address - City:KUNA
Mailing Address - State:ID
Mailing Address - Zip Code:83634-1710
Mailing Address - Country:US
Mailing Address - Phone:208-922-3465
Mailing Address - Fax:
Practice Address - Street 1:368 W KING RD
Practice Address - Street 2:
Practice Address - City:KUNA
Practice Address - State:ID
Practice Address - Zip Code:83634-1710
Practice Address - Country:US
Practice Address - Phone:208-922-3465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-10
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPTA-274225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant