Healthcare Provider Details

I. General information

NPI: 1528979929
Provider Name (Legal Business Name): REBECCA BLAIR MACDONALD PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1412 CORTELYOU RD
BROOKLYN NY
11226-5606
US

IV. Provider business mailing address

1412 CORTELYOU RD
BROOKLYN NY
11226-5606
US

V. Phone/Fax

Practice location:
  • Phone: 347-669-1011
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number056203
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: