Provider Demographics
NPI:1245616333
Name:GREINER, DONAVON LAINE
Entity Type:Individual
Prefix:MR
First Name:DONAVON
Middle Name:LAINE
Last Name:GREINER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3205 GRAND AVE APT 201
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-4172
Mailing Address - Country:US
Mailing Address - Phone:319-461-2724
Mailing Address - Fax:
Practice Address - Street 1:3205 GRAND AVE APT 201
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50312-4172
Practice Address - Country:US
Practice Address - Phone:319-461-2724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA077152225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist