Provider Demographics
NPI:1023538543
Name:DONOHUE, MEGAN LEIGH (DPT)
Entity Type:Individual
Prefix:MISS
First Name:MEGAN
Middle Name:LEIGH
Last Name:DONOHUE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1044 E JOHNSON ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-1624
Mailing Address - Country:US
Mailing Address - Phone:608-770-9503
Mailing Address - Fax:
Practice Address - Street 1:3401 MAPLE GROVE DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-5013
Practice Address - Country:US
Practice Address - Phone:920-542-1189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-26
Last Update Date:2017-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13839-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist