Healthcare Provider Details

I. General information

NPI: 1568146017
Provider Name (Legal Business Name): CAITLIN MCDONALD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CAITLIN CLARKE

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WONSETTLER RD
SCENERY HILL PA
15360-1863
US

IV. Provider business mailing address

100 WONSETTLER RD
SCENERY HILL PA
15360-1863
US

V. Phone/Fax

Practice location:
  • Phone: 724-945-5161
  • Fax:
Mailing address:
  • Phone: 724-945-5161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number721807
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberMP990017
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: