Healthcare Provider Details

I. General information

NPI: 1326950247
Provider Name (Legal Business Name): PATRICK STEVEN MCDONOUGH PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 W MAIN ST
CHESTER NJ
07930-2487
US

IV. Provider business mailing address

95 W MAIN ST
CHESTER NJ
07930-2487
US

V. Phone/Fax

Practice location:
  • Phone: 908-879-7364
  • Fax:
Mailing address:
  • Phone: 908-879-7364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number40QB00433700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: