MEDICARE: KELLY ANN MCDONALD PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	CP033497T	SC
2	225100000X	Physical Therapist	PT8400	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PT8400	OTHER	GA	STATE LISC NUMBER

General Provider Information

NPI Number	:	1235218033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY ANN MCDONALD PT

Provider Business Mailing Address
First Line	:	8823 PRODUCTION LN
Second Line	:
City	:	OOLTEWAH
State	:	TN
Zip	:	37363-6511
Country	:	US
Telephone Number	:	423-238-7217
Fax Number	:	423-238-3473

Provider Business Practice Location Address
First Line	:	16615 W CATAWBA AVE STE D
Second Line	:
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28078-8989
Country	:	US
Telephone Number	:	704-987-4322
Fax Number	:	704-987-7959

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2006
Last Update Date	:	08/29/2024

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Directions to “ KELLY ANN MCDONALD PT” Practice Location

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