Provider Demographics
NPI:1245656255
Name:SHORT, DONALD JR
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:
Last Name:SHORT
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 LONGVUE AVE
Mailing Address - Street 2:
Mailing Address - City:ALIQUIPPA
Mailing Address - State:PA
Mailing Address - Zip Code:15001-4518
Mailing Address - Country:US
Mailing Address - Phone:724-378-4982
Mailing Address - Fax:724-375-4839
Practice Address - Street 1:1215 LONGVUE AVE
Practice Address - Street 2:
Practice Address - City:ALIQUIPPA
Practice Address - State:PA
Practice Address - Zip Code:15001-4518
Practice Address - Country:US
Practice Address - Phone:724-378-4982
Practice Address - Fax:724-375-4839
Is Sole Proprietor?:No
Enumeration Date:2014-03-14
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART001806A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer