MEDICARE: ROBERT DONATELLI PT, PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1873	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891893939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT DONATELLI PT, PHD

Provider Business Mailing Address
First Line	:	7229 W SAHARA AVE STE 105
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-2860
Country	:	US
Telephone Number	:	702-586-2177
Fax Number	:	702-586-2358

Provider Business Practice Location Address
First Line	:	7229 WEST SAHARA AVE SUITE 105
Second Line	:	SUITE 105
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-4208
Country	:	US
Telephone Number	:	702-586-2177
Fax Number	:	702-586-2358

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	02/09/2017

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