Provider Demographics
NPI:1780603225
Name:DONATI, JOSEPH M (PT)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:M
Last Name:DONATI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 S 41ST ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-7316
Mailing Address - Country:US
Mailing Address - Phone:920-320-3100
Mailing Address - Fax:920-320-8616
Practice Address - Street 1:800 LAKEFRONT WAY
Practice Address - Street 2:
Practice Address - City:TWO RIVERS
Practice Address - State:WI
Practice Address - Zip Code:54241-3301
Practice Address - Country:US
Practice Address - Phone:920-320-2436
Practice Address - Fax:920-682-1981
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4352-0242251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI717685OtherT19 MANAGED HEALTH SERVIC
WI4033600Medicaid