Provider Demographics
NPI:1619930252
Name:DONOHUE, JOSEPH JOHN (PT)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:JOHN
Last Name:DONOHUE
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 1:2777 BRISTOL ST
Mailing Address - Street 2:STE B
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-5997
Mailing Address - Country:US
Mailing Address - Phone:949-250-1112
Mailing Address - Fax:949-250-1401
Practice Address - Street 1:2777 BRISTOL ST
Practice Address - Street 2:STE B
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-5997
Practice Address - Country:US
Practice Address - Phone:949-250-1112
Practice Address - Fax:949-250-1401
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13681225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT13681AMedicare UPIN