Provider Demographics
NPI:1497968598
Name:DONNELLY, KEVIN MARK (PT)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:MARK
Last Name:DONNELLY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 SE 17TH ST
Mailing Address - Street 2:302
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-9144
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2210 SE 17TH ST
Practice Address - Street 2:302
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-9144
Practice Address - Country:US
Practice Address - Phone:352-629-4509
Practice Address - Fax:352-629-5005
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24192251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic