Basic Information
| Provider Information | |||||||||
| NPI: | 1437256682 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DONNER | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MS, ATC, LAT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 SOUTH ST APT 19 | ||||||||
| Address2: | |||||||||
| City: | VERNON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060664431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8608109137 | ||||||||
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| Practice Location | |||||||||
| Address1: | 520 HARTFORD TPKE STE I | ||||||||
| Address2: | |||||||||
| City: | VERNON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060665043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8608708272 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | SC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.