1598086852 NPI number — DONNER PHYSICAL THERAPY AND SPORTS REHAB INC

Table of content: (NPI 1598086852)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598086852 NPI number — DONNER PHYSICAL THERAPY AND SPORTS REHAB INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DONNER PHYSICAL THERAPY AND SPORTS REHAB INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598086852
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/17/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1021 S UNIVERSITY DR
Provider Second Line Business Mailing Address:
SUITE 220
Provider Business Mailing Address City Name:
PLANTATION
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33324-3321
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-804-7501
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8040 PETERS RD STE H107
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLANTATION
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33324-4029
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-296-8258
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/21/2010

Additional Information

Authorized Official

Authorized Official Last Name:
DONNER
Authorized Official First Name:
MATT
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
954-804-7501

Provider Taxonomy Codes

  • Taxonomy code: 2251X0800X , with the licence number:  16055 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com