Provider Demographics
NPI:1366998247
Name:KLARDIE, DONNA LEE (PT)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:LEE
Last Name:KLARDIE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 MEMORIAL PKWY STE 208
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-2773
Mailing Address - Country:US
Mailing Address - Phone:908-847-6756
Mailing Address - Fax:908-847-6696
Practice Address - Street 1:755 MEMORIAL PKWY
Practice Address - Street 2:SUITE 208
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-2748
Practice Address - Country:US
Practice Address - Phone:908-847-6756
Practice Address - Fax:908-847-6696
Is Sole Proprietor?:No
Enumeration Date:2016-08-30
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00362700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist