Basic Information
| Provider Information | |||||||||
| NPI: | 1447588538 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DONLAN | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | BARRETT | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9368 N LILLEY RD | ||||||||
| Address2: | |||||||||
| City: | PLYMOUTH | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481704610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483632115 | ||||||||
| FaxNumber: | 2483632308 | ||||||||
| Practice Location | |||||||||
| Address1: | 8896 COMMERCE RD STE 1 | ||||||||
| Address2: | |||||||||
| City: | COMMERCE TOWNSHIP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483824494 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483632115 | ||||||||
| FaxNumber: | 2483632308 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2009 | ||||||||
| LastUpdateDate: | 10/05/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 032164 | NY | N | Other Service Providers | Specialist | 225100000X | 5501019532 | MI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.