Provider Demographics
NPI:1912539321
Name:DONNELLY, MICHAEL GEORGE JR (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:GEORGE
Last Name:DONNELLY
Suffix:JR
Gender:M
Credentials:PT, DPT
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Mailing Address - Street 1:2 DELAVERGNE AVE
Mailing Address - Street 2:
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-1202
Mailing Address - Country:US
Mailing Address - Phone:845-297-4789
Mailing Address - Fax:856-297-8596
Practice Address - Street 1:2 DELAVERGNE AVE
Practice Address - Street 2:
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-1202
Practice Address - Country:US
Practice Address - Phone:845-297-4789
Practice Address - Fax:856-297-8596
Is Sole Proprietor?:No
Enumeration Date:2020-02-04
Last Update Date:2020-02-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY045486225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1184655672OtherCAMPILII-SNYDER PHYSICAL THERAPY PC