MEDICARE: AMBER MCDONALD DPT

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	2016027635	MO

General Provider Information

NPI Number	:	1386199792
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER MCDONALD DPT

Provider Business Mailing Address
First Line	:	1431 SOUTHWEST BLVD
Second Line	:
City	:	JEFFERSON CITY
State	:	MO
Zip	:	65109-2468
Country	:	US
Telephone Number	:	573-636-9104
Fax Number	:

Provider Business Practice Location Address
First Line	:	2701 W EDGEWOOD DR STE 105
Second Line	:
City	:	JEFFERSON CITY
State	:	MO
Zip	:	65109-5890
Country	:	US
Telephone Number	:	573-761-5130
Fax Number	:

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

Provider Enumeration Date	:	08/16/2016
Last Update Date	:	08/20/2020

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