Provider Demographics
NPI:1134120959
Name:DONEY, ROSEANN (ATC, PTA)
Entity Type:Individual
Prefix:MRS
First Name:ROSEANN
Middle Name:
Last Name:DONEY
Suffix:
Gender:F
Credentials:ATC, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 LENHARDS LNDG
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48815-9792
Mailing Address - Country:US
Mailing Address - Phone:616-693-3133
Mailing Address - Fax:
Practice Address - Street 1:751 KENMOOR AVE SE
Practice Address - Street 2:SUITE H
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-2391
Practice Address - Country:US
Practice Address - Phone:616-975-9078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI225200000X, 2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer