Provider Demographics
NPI:1518006451
Name:DONALDSON, ROBERT (PT OCS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:DONALDSON
Suffix:
Gender:M
Credentials:PT OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:654 CREEKMONT CT
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-1400
Mailing Address - Country:US
Mailing Address - Phone:805-644-9091
Mailing Address - Fax:805-644-9096
Practice Address - Street 1:654 CREEKMONT CT
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-1400
Practice Address - Country:US
Practice Address - Phone:805-644-9091
Practice Address - Fax:805-644-9096
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT8117225100000X
CADC24339111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT8117BMedicare ID - Type UnspecifiedPHYSICAL THERAPY