Provider Demographics
NPI:1922192996
Name:DONOHOE, SUSAN (PT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:DONOHOE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 BLAIRS FERRY RD NE
Mailing Address - Street 2:SUITE C
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-1475
Mailing Address - Country:US
Mailing Address - Phone:319-393-6363
Mailing Address - Fax:319-393-6361
Practice Address - Street 1:600 BLAIRS FERRY RD NE
Practice Address - Street 2:SUITE C
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-1475
Practice Address - Country:US
Practice Address - Phone:319-393-6363
Practice Address - Fax:319-393-6361
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01075225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0665430Medicaid
IA16-6543Medicare ID - Type Unspecified