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NPI Code Detail

MEDICARE: KELLY MACDONALD P.T.

MEDICARE: KELLY MACDONALD 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
1225100000XPhysical TherapistPT29915CA

General Provider Information

NPI Number : 1396896163
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY MACDONALD P.T.
Provider Business Mailing Address
First Line : PO BOX 1848
Second Line :
City : NOVATO
State : CA
Zip : 94948-1848
Country : US
Telephone Number : 415-897-9195
Fax Number : 415-897-0346
Provider Business Practice Location Address
First Line : 246 1ST ST
Second Line : SUITE 101
City : SAN FRANCISCO
State : CA
Zip : 94105-2636
Country : US
Telephone Number : 415-897-9195
Fax Number : 415-897-0346
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/16/2007
Last Update Date : 07/08/2007

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