MEDICARE: LORNE T MACDONALD 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	7832	CO

General Provider Information

NPI Number	:	1629153986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORNE T MACDONALD DPT

Provider Business Mailing Address
First Line	:	4003 N WEBER ST
Second Line	:	UNIT I
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-4410
Country	:	US
Telephone Number	:	719-344-9497
Fax Number	:	719-358-6042

Provider Business Practice Location Address
First Line	:	4003 N WEBER ST
Second Line	:	UNIT I
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-4410
Country	:	US
Telephone Number	:	719-344-9497
Fax Number	:	719-358-6042

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

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	10/13/2016

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