Provider Demographics
NPI:1578539177
Name:DONACHIE, JENNY R (PT)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:R
Last Name:DONACHIE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:R
Other - Last Name:LARUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1325 SAN MARCO BLVD
Mailing Address - Street 2:STE 701
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-8568
Mailing Address - Country:US
Mailing Address - Phone:904-858-6418
Mailing Address - Fax:904-858-6490
Practice Address - Street 1:1577 ROBERTS DR
Practice Address - Street 2:SUITE 320
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-3264
Practice Address - Country:US
Practice Address - Phone:904-247-3324
Practice Address - Fax:904-247-3926
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT22522225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist