Provider Demographics
NPI:1194931527
Name:DONOVAN, KEITH ROBERT (PT)
Entity type:Individual
Prefix:MR
First Name:KEITH
Middle Name:ROBERT
Last Name:DONOVAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10112 CHICKADEE LN
Mailing Address - Street 2:
Mailing Address - City:ADELPHI
Mailing Address - State:MD
Mailing Address - Zip Code:20783-1216
Mailing Address - Country:US
Mailing Address - Phone:301-706-0688
Mailing Address - Fax:301-515-6039
Practice Address - Street 1:3 EXECUTIVE PARK CT
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-2643
Practice Address - Country:US
Practice Address - Phone:301-706-0688
Practice Address - Fax:301-540-0722
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16448225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist