Provider Demographics
NPI:1598300188
Name:DONOVAN, JOHN (DPT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:DONOVAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 TAMAL PLZ STE 120
Mailing Address - Street 2:
Mailing Address - City:CORTE MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:94925-1195
Mailing Address - Country:US
Mailing Address - Phone:415-461-8233
Mailing Address - Fax:415-461-6412
Practice Address - Street 1:200 TAMAL PLZ STE 120
Practice Address - Street 2:
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1195
Practice Address - Country:US
Practice Address - Phone:415-461-8233
Practice Address - Fax:415-461-6412
Is Sole Proprietor?:No
Enumeration Date:2019-11-07
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA296613225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist