MEDICARE: ROBERT JAMES MACDONALD II DR. PHYSICAL THERAPY

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	174400000X	Specialist	PT24666	CA

General Provider Information

NPI Number	:	1629182514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT JAMES MACDONALD II DR. PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	6301 FARINELLA DR
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-4221
Country	:	US
Telephone Number	:	714-840-5671
Fax Number	:	562-799-8832

Provider Business Practice Location Address
First Line	:	18800 MAIN ST
Second Line	:	SUITE 104
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-1707
Country	:	US
Telephone Number	:	714-843-9077
Fax Number	:	562-799-8832

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

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	07/08/2007

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