Provider Demographics
NPI:1043505209
Name:DONOHUE, MATTHEW (PT, DPT, ATC)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:DONOHUE
Suffix:
Gender:M
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 MARSH BROOK DRIVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SOMERSWORTH
Mailing Address - State:NH
Mailing Address - Zip Code:03878
Mailing Address - Country:US
Mailing Address - Phone:603-749-6686
Mailing Address - Fax:603-749-9270
Practice Address - Street 1:7 MARSH BROOK DRIVE
Practice Address - Street 2:SUITE 101
Practice Address - City:SOMERSWORTH
Practice Address - State:NH
Practice Address - Zip Code:03878
Practice Address - Country:US
Practice Address - Phone:603-749-6686
Practice Address - Fax:603-749-9270
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305206914225100000X
NH3731225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3731OtherPT LICENSE