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General NPI Number Information
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NPI Number | 1720277452
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Entity Type | Individual
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Provider Name | KENNETH IRVING MCDONALD P.T.
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Gender | Male
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Dates
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Enumeration Date | 10/18/2007
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Last Update Date | 09/18/2019
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Provider Practice Location Address
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Address Line | 600 W NORTH BLVD STE D
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City | LEESBURG
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State | FL
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Zip | 34748-5000
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Country | US
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Telephone | 352-728-6636
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Fax | 352-787-4522
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Provider Business Mailing Address
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Address Line | 600 W NORTH BLVD STE D
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City | LEESBURG
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State | FL
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Zip | 34748-5000
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Country | US
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Telephone | 352-728-6636
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Fax | 352-787-4522
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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 | PT 14744
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License Number State | CA
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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 | PT34821
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License Number State | FL
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