Provider Demographics
NPI:1740404755
Name:DONATO, GINA L (RPT)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:L
Last Name:DONATO
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 AUGUSTA ST
Mailing Address - Street 2:
Mailing Address - City:OAKVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06779-1022
Mailing Address - Country:US
Mailing Address - Phone:860-945-3224
Mailing Address - Fax:203-263-4050
Practice Address - Street 1:51 SHERMAN HILL RD STE A201
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:CT
Practice Address - Zip Code:06798-3694
Practice Address - Country:US
Practice Address - Phone:203-263-3104
Practice Address - Fax:203-263-4050
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0036902251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT003690OtherPHYSICAL THERAPY LICENSE