Provider Demographics
NPI:1235346255
Name:DONOVAN, KATHY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 BELMONT CT
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-5412
Mailing Address - Country:US
Mailing Address - Phone:908-902-1702
Mailing Address - Fax:
Practice Address - Street 1:200 SOMERSET ST
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1942
Practice Address - Country:US
Practice Address - Phone:732-258-7191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40 QA00129300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist