Provider Demographics
NPI:1992920011
Name:VALDEZ, DONNA JEAN (PT)
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:JEAN
Last Name:VALDEZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:DONNA
Other - Middle Name:JEAN
Other - Last Name:LABROSSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:8672 IRA AVE S
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55016-4720
Mailing Address - Country:US
Mailing Address - Phone:651-207-6253
Mailing Address - Fax:
Practice Address - Street 1:324 JOHNSON PKWY
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-6412
Practice Address - Country:US
Practice Address - Phone:651-793-3225
Practice Address - Fax:651-793-3213
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN245260AMedicare ID - Type UnspecifiedPROVIDER #