Provider Demographics
NPI:1265216113
Name:DONAHUE, AMANDA (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:
Last Name:DONAHUE
Suffix:
Gender:F
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 1:160 FREMONT ST UNIT 414
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01603-2376
Mailing Address - Country:US
Mailing Address - Phone:774-278-1274
Mailing Address - Fax:
Practice Address - Street 1:93 STAFFORD ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01603-1459
Practice Address - Country:US
Practice Address - Phone:508-593-1890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA27033225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist