Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | PT001953E | PA |
NPI | 1346463213 |
---|---|
Provider Name | Dorsey Donovan |
First Address | Philadelphia, PA 19144-2219 |
Second Address | Philadelphia, PA 19144-2219 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2007 |
Last Update Date | 08/07/2007 |