Provider Demographics
NPI:1629162797
Name:DONAHOE-FILLMORE, BETSY (PT, PHD)
Entity Type:Individual
Prefix:
First Name:BETSY
Middle Name:
Last Name:DONAHOE-FILLMORE
Suffix:
Gender:F
Credentials:PT, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 E US HIGHWAY 36
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:OH
Mailing Address - Zip Code:43078-9112
Mailing Address - Country:US
Mailing Address - Phone:937-653-7333
Mailing Address - Fax:937-652-4574
Practice Address - Street 1:1450 E US HIGHWAY 36
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:OH
Practice Address - Zip Code:43078-9112
Practice Address - Country:US
Practice Address - Phone:937-653-7333
Practice Address - Fax:937-652-4574
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT0047442251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2585573Medicaid
OH000000028494OtherANTHEM BC BS
OH000000028494OtherANTHEM BC BS
OHDO4153931Medicare ID - Type UnspecifiedMEDICARE