Provider Demographics
NPI:1083640551
Name:RALEY, DONALD JACK (PT)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:JACK
Last Name:RALEY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 US HIGHWAY 441 N
Mailing Address - Street 2:
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34972-1922
Mailing Address - Country:US
Mailing Address - Phone:863-763-8100
Mailing Address - Fax:863-763-8669
Practice Address - Street 1:1920 US HIGHWAY 441 N
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34972-1922
Practice Address - Country:US
Practice Address - Phone:863-763-8100
Practice Address - Fax:863-763-8669
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 19035225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT 19035OtherSTATE LICENSE
FLPT 19035OtherSTATE LICENSE