MEDICARE: DR. ANDREW 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	PT029889	PA

General Provider Information

NPI Number	:	1821768813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW MCDONALD DPT

Provider Business Mailing Address
First Line	:	150 S INDEPENDENCE MALL W APT 921
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19106-3424
Country	:	US
Telephone Number	:	267-205-9361
Fax Number	:

Provider Business Practice Location Address
First Line	:	1426 FRANKFORD AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19125-4410
Country	:	US
Telephone Number	:	215-427-6024
Fax Number	:

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

Provider Enumeration Date	:	09/20/2021
Last Update Date	:	02/03/2022

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