Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 4306 | OR |
N | 2251H1200X | Hand | ||
N | 2251H1200X | Hand | 4306 | OR |
NPI | 1528044211 |
---|---|
Provider Name | Edsen Donato |
First Address | Grants Pass, OR 97526-1257 |
Second Address | Grants Pass, OR 97526-1257 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2005 |
Last Update Date | 07/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
269923 | (05) | OR |