Provider Demographics
NPI:1588610463
Name:DONNELLY, PATRICK M (MS, ATC)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:M
Last Name:DONNELLY
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2000
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-0900
Mailing Address - Country:US
Mailing Address - Phone:607-753-5708
Mailing Address - Fax:607-753-5929
Practice Address - Street 1:1 FOLMER DRIVE
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045
Practice Address - Country:US
Practice Address - Phone:607-753-5708
Practice Address - Fax:607-753-5929
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0012232255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer