Provider Demographics
NPI:1114576949
Name:DONOVAN, TIAL ANN (DPT)
Entity Type:Individual
Prefix:DR
First Name:TIAL
Middle Name:ANN
Last Name:DONOVAN
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 1:4650 WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57703-6380
Mailing Address - Country:US
Mailing Address - Phone:605-769-0574
Mailing Address - Fax:
Practice Address - Street 1:2000 WESLEYAN BLVD
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-9340
Practice Address - Country:US
Practice Address - Phone:605-343-3555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist