Provider Demographics
NPI:1366286676
Name:DONALD, MARIAN (C-EP)
Entity type:Individual
Prefix:
First Name:MARIAN
Middle Name:
Last Name:DONALD
Suffix:
Gender:F
Credentials:C-EP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 WICKLOW CV
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-8082
Mailing Address - Country:US
Mailing Address - Phone:601-954-6969
Mailing Address - Fax:
Practice Address - Street 1:1040 RIVER OAKS DR STE 302
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9575
Practice Address - Country:US
Practice Address - Phone:800-610-6357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1067714224Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist