=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740164441
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN MACDONALD PT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2025
-----------------------------------------------------
Last Update Date | 08/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8452 BOSECK DR UNIT 248
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89145-2430
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-915-4132
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8452 BOSECK DR UNIT 248
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89145-2430
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-915-4132
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 5160
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------