Healthcare Provider Details

I. General information

NPI: 1841457280
Provider Name (Legal Business Name): KAREN MACDONALD MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2008
Last Update Date: 10/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 GATEWAY BLVD SUITE 2
ROCK SPRINGS WY
82901-6786
US

IV. Provider business mailing address

PO BOX 2400
ROCK SPRINGS WY
82902-2400
US

V. Phone/Fax

Practice location:
  • Phone: 307-352-3626
  • Fax: 307-352-3628
Mailing address:
  • Phone: 307-362-4336
  • Fax: 307-362-4339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberPT1624
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberPT-1278
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: