Provider Demographics
NPI:1972254373
Name:MASSOLA, DONELLA CELESTE (PTA)
Entity type:Individual
Prefix:
First Name:DONELLA
Middle Name:CELESTE
Last Name:MASSOLA
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 1:1302 NE 191ST ST APT 219
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33179-4886
Mailing Address - Country:US
Mailing Address - Phone:786-553-9546
Mailing Address - Fax:
Practice Address - Street 1:8262 GRIFFIN RD
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-3715
Practice Address - Country:US
Practice Address - Phone:954-368-4598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-17
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA31432225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant