MEDICARE: ANDREW SCOTT MACDONALD D.P.T.

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	PT 24883	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	77057605493065A003	OTHER	CA	TRICARE
2	PT00024883	OTHER	CA	BLUE CROSS OF CA
3	0PT248830	OTHER	CA	BLUE SHIELD OF CA

General Provider Information

NPI Number	:	1285681676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW SCOTT MACDONALD D.P.T.

Provider Business Mailing Address
First Line	:	2585 COCHRAN ST
Second Line	:	SUITE A
City	:	SIMI VALLEY
State	:	CA
Zip	:	93065-2602
Country	:	US
Telephone Number	:	805-584-0001
Fax Number	:	805-527-9135

Provider Business Practice Location Address
First Line	:	2585 COCHRAN ST
Second Line	:	SUITE A
City	:	SIMI VALLEY
State	:	CA
Zip	:	93065-2602
Country	:	US
Telephone Number	:	805-584-0001
Fax Number	:	805-527-9135

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

Provider Enumeration Date	:	05/30/2006
Last Update Date	:	09/17/2007

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Directions to “ ANDREW SCOTT MACDONALD D.P.T.” Practice Location

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