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General NPI Number Information
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NPI Number | 1497948509
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Entity Type | Organization
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Legal Business Name | MCDONALD REHAB, PC
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Dates
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Enumeration Date | 08/22/2007
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Last Update Date | 09/10/2015
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Provider Practice Location Address
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Address Line | 1800 FLANDRO DR SUITE 190
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City | POCATELLO
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State | ID
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Zip | 83202-4940
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Country | US
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Telephone | 208-233-2248
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Fax | 208-233-0219
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Provider Business Mailing Address
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Address Line | 1800 FLANDRO DR SUITE 190
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City | POCATELLO
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State | ID
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Zip | 83202-4940
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Country | US
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Telephone | 208-233-2248
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Fax | 208-233-0219
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Authorized Official
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Title or Position | OWNER
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Name | MR. BART W MCDONALD
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Credential | MPT
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Telephone | 208-233-2248
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT-884
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT-1555
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License Number State | ID
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