Provider Demographics
NPI:1376573873
Name:JOLLY, DONNA L (DPT)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:L
Last Name:JOLLY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:222 ROUTE 299
Mailing Address - Street 2:FIRSTCARE MEDICAL CENTER
Mailing Address - City:HIGHLAND
Mailing Address - State:NY
Mailing Address - Zip Code:12528-2524
Mailing Address - Country:US
Mailing Address - Phone:845-691-3627
Mailing Address - Fax:845-691-3641
Practice Address - Street 1:222 ROUTE 299
Practice Address - Street 2:FIRSTCARE MEDICAL CENTER
Practice Address - City:HIGHLAND
Practice Address - State:NY
Practice Address - Zip Code:12528-2524
Practice Address - Country:US
Practice Address - Phone:845-691-3627
Practice Address - Fax:845-691-3641
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016666-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00273845Medicaid
NY00273845Medicaid