Provider Demographics
NPI:1760098792
Name:DONELSON, SETH M (DPT)
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:M
Last Name:DONELSON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4337 EBENEZER RD
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-2143
Mailing Address - Country:US
Mailing Address - Phone:410-529-3303
Mailing Address - Fax:410-529-7980
Practice Address - Street 1:3700 FLEET ST STE 109
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-4238
Practice Address - Country:US
Practice Address - Phone:443-438-7214
Practice Address - Fax:443-438-7821
Is Sole Proprietor?:No
Enumeration Date:2020-09-16
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD28057225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist