Healthcare Provider Details

I. General information

NPI: 1225044183
Provider Name (Legal Business Name): SCOTT DAVID MACDONALD PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11301 COMMERCE DR SUITE B
ALLENDALE MI
49401-8200
US

IV. Provider business mailing address

12118 92ND AVE
WEST OLIVE MI
49460-9634
US

V. Phone/Fax

Practice location:
  • Phone: 616-443-7673
  • Fax:
Mailing address:
  • Phone: 616-892-4620
  • Fax: 815-642-4733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251E1200X
TaxonomyErgonomics Physical Therapist
License Number5501002672
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number5501002672
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: