Provider Demographics
NPI:1821157207
Name:DONOVAN, RICHARD J (PT)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:J
Last Name:DONOVAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1831 E CAYMAN RD
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32963-4534
Mailing Address - Country:US
Mailing Address - Phone:772-589-3600
Mailing Address - Fax:772-388-3305
Practice Address - Street 1:13852 US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-3231
Practice Address - Country:US
Practice Address - Phone:772-589-3600
Practice Address - Fax:772-388-3305
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL26552251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY4628AMedicare ID - Type UnspecifiedPHYSICAL THERAPY CLINIC