Provider Demographics
NPI:1255533030
Name:VIS, DONETTE L (MPT)
Entity type:Individual
Prefix:
First Name:DONETTE
Middle Name:L
Last Name:VIS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:DONETTE
Other - Middle Name:L
Other - Last Name:BRASE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:3420 34TH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601-1420
Mailing Address - Country:US
Mailing Address - Phone:402-910-8189
Mailing Address - Fax:
Practice Address - Street 1:3005 19TH ST STE 600
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-4248
Practice Address - Country:US
Practice Address - Phone:402-562-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1252225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist