Provider Demographics
NPI:1144281569
Name:BURNSIDE, DONNA MASON (PT)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:MASON
Last Name:BURNSIDE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:DONNA
Other - Middle Name:LYNN
Other - Last Name:MASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2065 MCDADE RD
Mailing Address - Street 2:
Mailing Address - City:HEPHZIBAH
Mailing Address - State:GA
Mailing Address - Zip Code:30815-4721
Mailing Address - Country:US
Mailing Address - Phone:706-592-6396
Mailing Address - Fax:706-592-6872
Practice Address - Street 1:2065 MCDADE RD
Practice Address - Street 2:
Practice Address - City:HEPHZIBAH
Practice Address - State:GA
Practice Address - Zip Code:30815-4721
Practice Address - Country:US
Practice Address - Phone:706-592-6396
Practice Address - Fax:706-592-6872
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT002888225100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics