Provider Demographics
NPI:1174723233
Name:VERFAILIE, DONNA
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:
Last Name:VERFAILIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 SE SAINT LUCIE BLVD
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34996-2642
Mailing Address - Country:US
Mailing Address - Phone:772-692-6928
Mailing Address - Fax:
Practice Address - Street 1:701 NW FEDERAL HWY
Practice Address - Street 2:SUITE 403
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-1005
Practice Address - Country:US
Practice Address - Phone:772-692-6928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA3527225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA3527OtherLISCENCE