Provider Demographics
NPI:1225044183
Name:MACDONALD, SCOTT DAVID (PT)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:DAVID
Last Name:MACDONALD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12118 92ND AVE
Mailing Address - Street 2:
Mailing Address - City:WEST OLIVE
Mailing Address - State:MI
Mailing Address - Zip Code:49460-9634
Mailing Address - Country:US
Mailing Address - Phone:616-892-4620
Mailing Address - Fax:815-642-4733
Practice Address - Street 1:11301 COMMERCE DR
Practice Address - Street 2:SUITE B
Practice Address - City:ALLENDALE
Practice Address - State:MI
Practice Address - Zip Code:49401-8200
Practice Address - Country:US
Practice Address - Phone:616-443-7673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI55010026722251E1200X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2251E1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistErgonomics
Not Answered2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic