Healthcare Provider Details

I. General information

NPI: 1669471983
Provider Name (Legal Business Name): MICHAEL DONEGAN P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 COLLINS ST
AVON NY
14414-1466
US

IV. Provider business mailing address

490 COLLINS ST
AVON NY
14414-1466
US

V. Phone/Fax

Practice location:
  • Phone: 585-226-2480
  • Fax: 585-226-2494
Mailing address:
  • Phone: 585-226-2480
  • Fax: 585-226-2494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number020146
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: