Provider Demographics
NPI:1407902216
Name:DONAYRE, GERARD (MPT, OCS)
Entity Type:Individual
Prefix:MR
First Name:GERARD
Middle Name:
Last Name:DONAYRE
Suffix:
Gender:M
Credentials:MPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1921 N GAFFEY ST
Mailing Address - Street 2:SUITE I
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-1264
Mailing Address - Country:US
Mailing Address - Phone:310-833-0300
Mailing Address - Fax:310-833-0306
Practice Address - Street 1:1921 N GAFFEY ST
Practice Address - Street 2:SUITE I
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-1264
Practice Address - Country:US
Practice Address - Phone:310-833-0300
Practice Address - Fax:310-833-0306
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT28434225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist