Provider Demographics
NPI:1588630594
Name:HOWARD, DONALD L (ATC, PTA)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:L
Last Name:HOWARD
Suffix:
Gender:M
Credentials:ATC, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 W CLAYTON RD
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-7106
Mailing Address - Country:US
Mailing Address - Phone:618-521-0106
Mailing Address - Fax:
Practice Address - Street 1:200 N EMERALD LN
Practice Address - Street 2:SUITE 1A
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-2100
Practice Address - Country:US
Practice Address - Phone:618-549-9449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225200000X, 2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer