Provider Demographics
NPI:1104981331
Name:DONLY, JOSEPH R
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:R
Last Name:DONLY
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 1:2 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MARCUS HOOK
Mailing Address - State:PA
Mailing Address - Zip Code:19061-4513
Mailing Address - Country:US
Mailing Address - Phone:610-859-8850
Mailing Address - Fax:610-859-7876
Practice Address - Street 1:1331 E WYOMING AVE
Practice Address - Street 2:SUITE 4120
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124-3808
Practice Address - Country:US
Practice Address - Phone:215-831-1170
Practice Address - Fax:215-744-7394
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT013159L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0188461701OtherAMERICHOICE
PA0015717000OtherIBC
PA01884617Medicaid
1160738OtherKEYSTONE MERCY
PA053903VLZOtherMEDICARE ID
PADO343174OtherPA BL SHIELD
PAP00692850OtherRAILROAD MEDICARE