Provider Demographics
NPI:1013549799
Name:MCDONALD, MARCY ANN
Entity Type:Individual
Prefix:
First Name:MARCY
Middle Name:ANN
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2930 N TARRA AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-4933
Mailing Address - Country:US
Mailing Address - Phone:434-774-7111
Mailing Address - Fax:
Practice Address - Street 1:2930 N TARRA AVE UNIT B
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-4933
Practice Address - Country:US
Practice Address - Phone:434-774-7111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer