Healthcare Provider Details

I. General information

NPI: 1265093801
Provider Name (Legal Business Name): JOHN F DONEGAN PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2019
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 VICTORIA ST
GLASSBORO NJ
08028-2278
US

IV. Provider business mailing address

224 STRAWBRIDGE DR STE 100
MOORESTOWN NJ
08057-4602
US

V. Phone/Fax

Practice location:
  • Phone: 856-536-1475
  • Fax:
Mailing address:
  • Phone: 856-677-4000
  • Fax: 856-234-3014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01863000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: