Healthcare Provider Details

I. General information

NPI: 1023926037
Provider Name (Legal Business Name): TREY JAMES MCDONALD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 LANSING ST
AUBURN NY
13021-1983
US

IV. Provider business mailing address

105 WATERWAGON RD
ITHACA NY
14850-9762
US

V. Phone/Fax

Practice location:
  • Phone: 315-255-7011
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number053048-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: