Healthcare Provider Details

I. General information

NPI: 1053229625
Provider Name (Legal Business Name): NINA DONAHUE
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4934 MAIN ST
DOWNERS GROVE IL
60515-3611
US

IV. Provider business mailing address

4934 MAIN ST
DOWNERS GROVE IL
60515-3611
US

V. Phone/Fax

Practice location:
  • Phone: 630-964-4008
  • Fax: 630-964-4117
Mailing address:
  • Phone: 630-964-4008
  • Fax: 630-964-4117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070.040734
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: