Basic Information
| Provider Information | |||||||||
| NPI: | 1760627947 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DONAHUE | ||||||||
| FirstName: | STACEY | ||||||||
| MiddleName: | IANTHE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3247 RAMBLER DR | ||||||||
| Address2: | |||||||||
| City: | NATRONA HEIGHTS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150651832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7242241957 | ||||||||
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| Practice Location | |||||||||
| Address1: | 885 MACBETH DR | ||||||||
| Address2: | |||||||||
| City: | MONROEVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151463332 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4128567071 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2008 | ||||||||
| LastUpdateDate: | 12/02/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | TE005419L | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.