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General NPI Number Information
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NPI Number | 1013057611
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Entity Type | Organization
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Legal Business Name | DONAHUE PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4925 W BELL RD
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City | GLENDALE
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State | AZ
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Zip | 85308-3427
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Country | US
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Telephone | 602-318-5556
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Fax | 602-789-6755
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Provider Business Mailing Address
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Address Line | 11038 N 28TH DR APT 123
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City | PHOENIX
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State | AZ
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Zip | 85029-4308
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Country | US
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Telephone | 602-318-5556
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Fax | 602-789-6755
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Authorized Official
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Title or Position | OWNER PHYSICAL THERAPIST
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Name | MARK CHARLES DONAHUE
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Credential | MSPT
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Telephone | 602-318-5556
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5998
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License Number State | AZ
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