Provider Demographics
NPI:1417741075
Name:DONADIO, GREGORY (LMT, DN)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:DONADIO
Suffix:
Gender:
Credentials:LMT, DN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4623 HOLLISTER AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463-2533
Mailing Address - Country:US
Mailing Address - Phone:518-470-7054
Mailing Address - Fax:
Practice Address - Street 1:651 EGRET CIR
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33444-7931
Practice Address - Country:US
Practice Address - Phone:518-470-7054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-08
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA98888225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist