Healthcare Provider Details

I. General information

NPI: 1801870225
Provider Name (Legal Business Name): DONALD ALAN MILDREW PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 04/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1024 INDEPENDENCE BLVD
VIRGINIA BEACH VA
23455-5503
US

IV. Provider business mailing address

PO BOX 69030
BALTIMORE MD
21264-9030
US

V. Phone/Fax

Practice location:
  • Phone: 757-460-3363
  • Fax: 757-460-1809
Mailing address:
  • Phone: 757-873-2302
  • Fax: 757-873-2306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305001466
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: