MEDICARE: DEBORAH DONNELLY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	5502000769	MI
2	225200000X	Physical Therapy Assistant

General Provider Information

NPI Number	:	1437536497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH DONNELLY

Provider Business Mailing Address
First Line	:	117 DUNTON AVE
Second Line	:
City	:	HOLLAND
State	:	MI
Zip	:	49424-2103
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3650 VAN BUREN ST
Second Line	:
City	:	HUDSONVILLE
State	:	MI
Zip	:	49426-1097
Country	:	US
Telephone Number	:	616-669-1520
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/29/2015
Last Update Date	:	12/26/2024

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Directions to “ DEBORAH DONNELLY ” Practice Location

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