Provider Demographics
NPI:1598086852
Name:DONNER PHYSICAL THERAPY AND SPORTS REHAB INC
Entity Type:Organization
Organization Name:DONNER PHYSICAL THERAPY AND SPORTS REHAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:DONNER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:954-804-7501
Mailing Address - Street 1:1021 S UNIVERSITY DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3321
Mailing Address - Country:US
Mailing Address - Phone:954-804-7501
Mailing Address - Fax:
Practice Address - Street 1:8040 PETERS RD STE H107
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-4029
Practice Address - Country:US
Practice Address - Phone:954-296-8258
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-21
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL160552251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty