Provider Demographics
NPI:1497085393
Name:DOLATO, DONNOVAN (ATC, CSCS, NSCA-CPT)
Entity Type:Individual
Prefix:
First Name:DONNOVAN
Middle Name:
Last Name:DOLATO
Suffix:
Gender:M
Credentials:ATC, CSCS, NSCA-CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1079 E 8320 S
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-0708
Mailing Address - Country:US
Mailing Address - Phone:801-712-5626
Mailing Address - Fax:
Practice Address - Street 1:10996 RIVER FRONT PKWY
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-3538
Practice Address - Country:US
Practice Address - Phone:801-302-0909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-28
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer