Healthcare Provider Details

I. General information

NPI: 1417083718
Provider Name (Legal Business Name): MARILYN MAILHOT MCDONALD PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14480 CHAMY DR
RENO NV
89521-7313
US

IV. Provider business mailing address

14480 CHAMY DR
RENO NV
89521-7313
US

V. Phone/Fax

Practice location:
  • Phone: 775-741-3655
  • Fax: 775-851-1908
Mailing address:
  • Phone: 775-741-3655
  • Fax: 775-851-1908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number0769
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: