Provider Demographics
NPI:1629071444
Name:DONELAN, MATTHEW BARTON (PT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:BARTON
Last Name:DONELAN
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 1:720 N HIGHWAY 6
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:NE
Mailing Address - Zip Code:68028-7950
Mailing Address - Country:US
Mailing Address - Phone:402-332-3773
Mailing Address - Fax:402-332-2939
Practice Address - Street 1:720 N HIGHWAY 6
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:NE
Practice Address - Zip Code:68028-7950
Practice Address - Country:US
Practice Address - Phone:402-332-3773
Practice Address - Fax:402-332-2939
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE753225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist