Provider Demographics
NPI:1538443718
Name:MCDONALD, DEANNA K (PTA)
Entity type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:K
Last Name:MCDONALD
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 1:12100 DEER RUN
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-8402
Mailing Address - Country:US
Mailing Address - Phone:919-846-6255
Mailing Address - Fax:
Practice Address - Street 1:12100 DEER RUN
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-8402
Practice Address - Country:US
Practice Address - Phone:919-846-6255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2891225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant