Healthcare Provider Details

I. General information

NPI: 1588610463
Provider Name (Legal Business Name): PATRICK M DONNELLY MS, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 06/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 FOLMER DRIVE
CORTLAND NY
13045
US

IV. Provider business mailing address

PO BOX 2000
CORTLAND NY
13045-0900
US

V. Phone/Fax

Practice location:
  • Phone: 607-753-5708
  • Fax: 607-753-5929
Mailing address:
  • Phone: 607-753-5708
  • Fax: 607-753-5929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number001223
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: