Provider Demographics
NPI:1912977422
Name:ALINE, DONNA MARY (PT)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:MARY
Last Name:ALINE
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 1:29 PINE RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:CLANCY
Mailing Address - State:MT
Mailing Address - Zip Code:59634-9760
Mailing Address - Country:US
Mailing Address - Phone:406-933-5969
Mailing Address - Fax:
Practice Address - Street 1:2442 WINNE AVE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-4915
Practice Address - Country:US
Practice Address - Phone:406-449-7887
Practice Address - Fax:406-449-7888
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT130174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT168678OtherWAWC
MTMSF0520433OtherMT STATE FUND
MT650019573OtherRR MEDICARE
MT000061230OtherBLUE CROSS
MT0341496Medicaid
MT841391220003OtherEBMS
MTMSF0520433OtherMT STATE FUND