Provider Demographics
NPI:1700114188
Name:BASEHORE, DONNA A (PT)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:A
Last Name:BASEHORE
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 1:319 BRAEBURN DR
Mailing Address - Street 2:
Mailing Address - City:ETTERS
Mailing Address - State:PA
Mailing Address - Zip Code:17319-8937
Mailing Address - Country:US
Mailing Address - Phone:717-938-4916
Mailing Address - Fax:
Practice Address - Street 1:503 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:NEW CUMBERLAND
Practice Address - State:PA
Practice Address - Zip Code:17070-1972
Practice Address - Country:US
Practice Address - Phone:717-695-2500
Practice Address - Fax:717-695-2550
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-24
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT002100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA062899Medicare UPIN