Provider Demographics
NPI:1699768085
Name:VALENTINE, DONITA YVETTE (ATC)
Entity type:Individual
Prefix:MS
First Name:DONITA
Middle Name:YVETTE
Last Name:VALENTINE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 WELSH HILL RD
Mailing Address - Street 2:APT 2
Mailing Address - City:FROSTBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21532-2332
Mailing Address - Country:US
Mailing Address - Phone:301-412-8797
Mailing Address - Fax:
Practice Address - Street 1:1 BRADDOCK RD
Practice Address - Street 2:CORDTS PHYSICAL EDUCATION CENTER
Practice Address - City:FROSTBURG
Practice Address - State:MD
Practice Address - Zip Code:21532-2366
Practice Address - Country:US
Practice Address - Phone:301-687-4208
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDV4531499681462255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer