=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467053280
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES FRANCIS DONOVAN PT, DPT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/06/2020
-----------------------------------------------------
Last Update Date | 11/07/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 22 CORPORATE PLAZA DR # 113
-----------------------------------------------------
City | NEWPORT BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92660-7985
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-722-5054
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1100 CALLE DEL CERRO APT 151L
-----------------------------------------------------
City | SAN CLEMENTE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92672-6029
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-901-9397
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 299386
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------