Provider Demographics
NPI:1093488678
Name:DONITHAN, JANA A (PTA)
Entity Type:Individual
Prefix:
First Name:JANA
Middle Name:A
Last Name:DONITHAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4050 OLD MAYSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-9310
Mailing Address - Country:US
Mailing Address - Phone:859-585-3382
Mailing Address - Fax:
Practice Address - Street 1:39 S MAYSVILLE ST
Practice Address - Street 2:
Practice Address - City:MOUNT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-1354
Practice Address - Country:US
Practice Address - Phone:859-520-3171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA04253225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1578185039Medicaid