Provider Demographics
NPI:1447568803
Name:DETORE, DONNA M (DPT)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:M
Last Name:DETORE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:96-98 MILLBURN AVENUE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:96-98 MILLBURN AVENUE
Practice Address - Street 2:SUITE 102
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041
Practice Address - Country:US
Practice Address - Phone:973-486-0212
Practice Address - Fax:973-486-0212
Is Sole Proprietor?:No
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ40QA01368100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist