Provider Demographics
NPI:1750623617
Name:DONAHUE, MARC JASON
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:JASON
Last Name:DONAHUE
Suffix:
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 1:410 S MACLAND AVE
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:MO
Mailing Address - Zip Code:64060-7684
Mailing Address - Country:US
Mailing Address - Phone:816-903-0214
Mailing Address - Fax:
Practice Address - Street 1:410 S MACLAND AVE
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:MO
Practice Address - Zip Code:64060-7684
Practice Address - Country:US
Practice Address - Phone:816-903-0214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-19
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant