Provider Demographics
NPI:1154675775
Name:MACDONALD, ALICIA LOUISE (DPT)
Entity type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:LOUISE
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5835 SE OGDEN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-7551
Mailing Address - Country:US
Mailing Address - Phone:321-213-7930
Mailing Address - Fax:
Practice Address - Street 1:905 SE ANKENY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-1349
Practice Address - Country:US
Practice Address - Phone:321-213-7930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-05
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT-27905225100000X
ARPT 4260225100000X
OR63813225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR229940721Medicaid