Provider Demographics
NPI:1801870225
Name:MILDREW, DONALD ALAN (PT)
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:ALAN
Last Name:MILDREW
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 69030
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-9030
Mailing Address - Country:US
Mailing Address - Phone:757-873-2302
Mailing Address - Fax:757-873-2306
Practice Address - Street 1:1024 INDEPENDENCE BLVD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-5503
Practice Address - Country:US
Practice Address - Phone:757-460-3363
Practice Address - Fax:757-460-1809
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305001466225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA081988OtherANTHEM - BCBS
VA216563OtherMD.IPA/OPTIMUM CHOICE/ALL
VAC05954OtherGROUP MEDICARE PTAN
VA216563OtherMD.IPA/OPTIMUM CHOICE/ALL