Provider Demographics
NPI:1649456195
Name:DONOVAN, JULIE ANN (CMPTP CERTIFIED MYOF)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:ANN
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:CMPTP CERTIFIED MYOF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 NORTH STREET
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:MA
Mailing Address - Zip Code:01226
Mailing Address - Country:US
Mailing Address - Phone:413-684-0340
Mailing Address - Fax:413-684-0340
Practice Address - Street 1:33 NORTH STREET
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:MA
Practice Address - Zip Code:01226
Practice Address - Country:US
Practice Address - Phone:413-684-0340
Practice Address - Fax:413-684-0340
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA005208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation