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General NPI Number Information
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NPI Number | 1104017268
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Entity Type | Individual
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Provider Name | SETH ANGUS MCDONALD DPT
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Gender | Male
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Dates
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Enumeration Date | 08/05/2007
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Last Update Date | 08/05/2007
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Provider Practice Location Address
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Address Line | 1050 E MOUNTAIN VIEW AVE
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City | ELLENSBURG
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State | WA
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Zip | 98926-3930
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Country | US
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Telephone | 406-370-7219
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Fax |
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Provider Business Mailing Address
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Address Line | 1508 N B ST APT 1204
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City | ELLENSBURG
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State | WA
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Zip | 98926-5610
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Country | US
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Telephone | 406-370-7219
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT00010243
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License Number State | WA
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