Healthcare Provider Details

I. General information

NPI: 1609767169
Provider Name (Legal Business Name): ALIYAH MCDONALD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2025
Last Update Date: 07/14/2025
Certification Date: 07/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1643 LANCASTER DR STE 100
GRAPEVINE TX
76051-3593
US

IV. Provider business mailing address

749 SCOTLAND RD APT 1A
ORANGE NJ
07050-1085
US

V. Phone/Fax

Practice location:
  • Phone: 817-329-2524
  • Fax:
Mailing address:
  • Phone: 313-247-9147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: