Provider Demographics
NPI:1902545015
Name:DONOU, CARLOS KOMLAN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:KOMLAN
Last Name:DONOU
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 CYPRUS LN APT A
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-2071
Mailing Address - Country:US
Mailing Address - Phone:732-609-3798
Mailing Address - Fax:
Practice Address - Street 1:21 CYPRUS LN APT A
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-2071
Practice Address - Country:US
Practice Address - Phone:732-609-3798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-27
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02089700225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty