Healthcare Provider Details

I. General information

NPI: 1093313546
Provider Name (Legal Business Name): MATTHEW RYAN MCDONALD DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2020
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1417 S POLLOCK ST
SELMA NC
27576-3405
US

IV. Provider business mailing address

2122 YORK RD STE 300
OAK BROOK IL
60523-1925
US

V. Phone/Fax

Practice location:
  • Phone: 919-300-5040
  • Fax: 919-438-0893
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP19784
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: