Provider Demographics
NPI:1437256682
Name:DONNER, DAVID A (MS, ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:A
Last Name:DONNER
Suffix:
Gender:M
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 SOUTH ST APT 19
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-4431
Mailing Address - Country:US
Mailing Address - Phone:860-810-9137
Mailing Address - Fax:
Practice Address - Street 1:520 HARTFORD TPKE STE I
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-5043
Practice Address - Country:US
Practice Address - Phone:860-870-8272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer