Provider Demographics
NPI:1902273733
Name:DONOVAN, PATRICK (DPT)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:
Last Name:DONOVAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W 11TH AVE UNIT 6J
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-3663
Mailing Address - Country:US
Mailing Address - Phone:708-415-0827
Mailing Address - Fax:
Practice Address - Street 1:300 W 11TH AVE UNIT 6J
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-3663
Practice Address - Country:US
Practice Address - Phone:708-415-0827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-27
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0013308225100000X
261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist