Provider Demographics
NPI:1871981936
Name:DONOVAN, RYAN MICHAEL (PT)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:MICHAEL
Last Name:DONOVAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 WHEATLAND CIR
Mailing Address - Street 2:
Mailing Address - City:BRIDGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15017-1121
Mailing Address - Country:US
Mailing Address - Phone:412-715-3268
Mailing Address - Fax:
Practice Address - Street 1:480 JOHNSON RD
Practice Address - Street 2:SUITE 303
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-8936
Practice Address - Country:US
Practice Address - Phone:724-223-2061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-24
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT025783225100000X
PATEI004109225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant