Active NPI
Donna Marie Gorton-Childers, PT
- Physical Therapist
- South Charleston, WV
National Provider Identifier
1720290976
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 446
- Practice address
- 4605 Maccorkle Ave SW
South Charleston, WV 25309-1311 - Phone
- (304) 766-3589
- Fax
- (304) 766-3793
- NPI assigned
- May 3, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 446 | WV | Primary |
| Physical Therapist | 225100000X | 4086 | MA |
Addresses
Primary practice location
4605 Maccorkle Ave SW
South Charleston, WV 25309-1311
Mailing address
1904 Woodside Cir
Charleston, WV 25314-2256
Phone (304) 346-0703
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 257882 | Other | WV | MAMSI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4086 | MA | MD | Corneal and Contact Management Optometrist |
| 446 | WV | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178150400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1268179200000",
"number": "1720290976",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1904 WOODSIDE CIR",
"city": "CHARLESTON",
"state": "WV",
"postal_code": "253142256",
"telephone_number": "304-346-0703",
"fax_number": "304-766-3793"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4605 MACCORKLE AVE SW",
"city": "SOUTH CHARLESTON",
"state": "WV",
"postal_code": "253091311",
"telephone_number": "304-766-3589",
"fax_number": "304-766-3793"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORTON-CHILDERS",
"first_name": "DONNA",
"middle_name": "MARIE",
"name_prefix": "Mrs.",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-03",
"last_updated": "2010-03-10",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WV",
"license": "446",
"primary": true
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MA",
"license": "4086",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAMSI",
"identifier": "257882",
"state": "WV"
}
],
"endpoints": [],
"other_names": []
}Other providers in South Charleston, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.