Healthcare Provider Details

I. General information

NPI: 1629071444
Provider Name (Legal Business Name): MATTHEW BARTON DONELAN PT
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 N HIGHWAY 6
GRETNA NE
68028-7950
US

IV. Provider business mailing address

720 N HIGHWAY 6
GRETNA NE
68028-7950
US

V. Phone/Fax

Practice location:
  • Phone: 402-332-3773
  • Fax: 402-332-2939
Mailing address:
  • Phone: 402-332-3773
  • Fax: 402-332-2939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number753
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: