MEDICARE: SANDRA ANN MCDONALD P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1424	AR

General Provider Information

NPI Number	:	1427083377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA ANN MCDONALD P.T.

Provider Business Mailing Address
First Line	:	PO BOX 489
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72115-0489
Country	:	US
Telephone Number	:	501-753-5189
Fax Number	:	501-753-0255

Provider Business Practice Location Address
First Line	:	505 W PERSHING BLVD
Second Line	:	SUITE D.
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72114-2147
Country	:	US
Telephone Number	:	501-753-5189
Fax Number	:	501-753-0255

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	07/08/2007

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