Provider Demographics
NPI:1114597564
Name:DONOHUE, JEANINE MARIE TOTILO (PT)
Entity Type:Individual
Prefix:
First Name:JEANINE
Middle Name:MARIE TOTILO
Last Name:DONOHUE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JEANINE
Other - Middle Name:MARIE
Other - Last Name:TOTILO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:2339 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94116-2338
Mailing Address - Country:US
Mailing Address - Phone:917-837-8410
Mailing Address - Fax:
Practice Address - Street 1:1600 OWENS ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94158-2261
Practice Address - Country:US
Practice Address - Phone:415-833-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-29
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32016225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist