Provider Demographics
NPI:1568684439
Name:BERRYHILL, DONNA B (PTA)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:B
Last Name:BERRYHILL
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 1:414 E.S.'E' STREET
Mailing Address - Street 2:
Mailing Address - City:GAS CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46933
Mailing Address - Country:US
Mailing Address - Phone:765-674-7041
Mailing Address - Fax:765-677-4369
Practice Address - Street 1:4725 SOUTH COLONIAL OAKS DRIVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46953
Practice Address - Country:US
Practice Address - Phone:765-674-9791
Practice Address - Fax:765-677-4369
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06002244A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant