Provider Demographics
NPI:1417456856
Name:ANTHONY, DONALD (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:ANTHONY
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 TIMBER DR E
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-6924
Mailing Address - Country:US
Mailing Address - Phone:919-863-6991
Mailing Address - Fax:
Practice Address - Street 1:1325 TIMBER DR E
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-6924
Practice Address - Country:US
Practice Address - Phone:919-863-6991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-11
Last Update Date:2018-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLAT-25552255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer