Healthcare Provider Details

I. General information

NPI: 1912903063
Provider Name (Legal Business Name): FRANCIS J MCDONALD PT
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 N HICKORY RD
SOUTH BEND IN
46615-3723
US

IV. Provider business mailing address

1005 N HICKORY RD
SOUTH BEND IN
46615-3723
US

V. Phone/Fax

Practice location:
  • Phone: 574-233-5754
  • Fax: 574-233-7406
Mailing address:
  • Phone: 574-233-5754
  • Fax: 574-233-7406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number53000037
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: