Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251S0007X | Physical Therapist - Sports | 16320 | MA |
N | 2251X0800X | Physical Therapist - Orthopedic | 16320 | MA |
NPI | 1053464388 |
---|---|
Provider Name | Ms. Donna Elizabeth Wiejkus |
First Address | Quincy, MA 02169 |
Second Address | Brookline, MA 02445-7163 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2007 |
Last Update Date | 08/07/2007 |