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General NPI Number Information
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NPI Number | 1710301734
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Entity Type | Individual
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Provider Name | RYAN PATRICK DONAHUE PT
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Gender | Male
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Dates
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Enumeration Date | 02/11/2014
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Last Update Date | 02/11/2014
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Provider Practice Location Address
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Address Line | 600 N ROBBINS RD
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City | BOISE
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State | ID
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Zip | 83702-4565
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Country | US
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Telephone | 208-489-4444
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Fax |
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Provider Business Mailing Address
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Address Line | 1728 S ANNETT ST
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City | BOISE
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State | ID
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Zip | 83705-3168
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Country | US
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Telephone | 651-210-4117
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | PT-1942
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License Number State | ID
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