Provider Demographics
NPI:1891893939
Name:DONATELLI, ROBERT (PT, PHD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:DONATELLI
Suffix:
Gender:M
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 1:7229 W SAHARA AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-2860
Mailing Address - Country:US
Mailing Address - Phone:702-586-2177
Mailing Address - Fax:702-586-2358
Practice Address - Street 1:7229 WEST SAHARA AVE SUITE 105
Practice Address - Street 2:SUITE 105
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-4208
Practice Address - Country:US
Practice Address - Phone:702-586-2177
Practice Address - Fax:702-586-2358
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1873225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100507392Medicaid
NV100507392Medicaid
NVV101780Medicare PIN