Provider Demographics
NPI:1588641211
Name:DONLEY, CHARLES C (PT)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:C
Last Name:DONLEY
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 1:19387 HIDDEN OAKS DRIVE
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34604
Mailing Address - Country:US
Mailing Address - Phone:352-688-8066
Mailing Address - Fax:352-688-8540
Practice Address - Street 1:465 MARINER BLVD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-5680
Practice Address - Country:US
Practice Address - Phone:352-688-8066
Practice Address - Fax:352-688-8540
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT-0004876225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL886710100Medicaid
FLY8453Medicare PIN