| NPI | 1164487021 |
|---|---|
| Former Name | DONNA LEANN TYSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA 3999) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 3999) |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2008-02-29 |