Provider Demographics
NPI:1053822874
Name:MCBRIDE, DONNIE JR (LMT)
Entity Type:Individual
Prefix:MR
First Name:DONNIE
Middle Name:
Last Name:MCBRIDE
Suffix:JR
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:551 N KARLE ST
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-7412
Mailing Address - Country:US
Mailing Address - Phone:734-331-0885
Mailing Address - Fax:
Practice Address - Street 1:551 N KARLE ST
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-7412
Practice Address - Country:US
Practice Address - Phone:734-331-0885
Practice Address - Fax:734-331-0885
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-19
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501001009225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist