Basic Information
| Provider Information | |||||||||
| NPI: | 1760098792 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DONELSON | ||||||||
| FirstName: | SETH | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4337 EBENEZER RD | ||||||||
| Address2: | |||||||||
| City: | NOTTINGHAM | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212362143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105293303 | ||||||||
| FaxNumber: | 4105297980 | ||||||||
| Practice Location | |||||||||
| Address1: | 3700 FLEET ST STE 109 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212244238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4434387214 | ||||||||
| FaxNumber: | 4434387821 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2020 | ||||||||
| LastUpdateDate: | 12/15/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 28057 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.