Healthcare Provider Details

I. General information

NPI: 1649875105
Provider Name (Legal Business Name): DENIS DONOVAN DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2020
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4215 BURNS RD STE 100
PALM BEACH GARDENS FL
33410-4627
US

IV. Provider business mailing address

4215 BURNS RD STE 200
PALM BEACH GARDENS FL
33410-4625
US

V. Phone/Fax

Practice location:
  • Phone: 561-694-7776
  • Fax: 561-694-3099
Mailing address:
  • Phone: 561-694-7776
  • Fax: 561-694-3099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number046686
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: