Provider Demographics
NPI:1275640583
Name:MCDONALD, GAYLE MARIE (ATC)
Entity Type:Individual
Prefix:MS
First Name:GAYLE
Middle Name:MARIE
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:728 HEARN ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:TN
Mailing Address - Zip Code:38340-2502
Mailing Address - Country:US
Mailing Address - Phone:731-989-7578
Mailing Address - Fax:731-983-3117
Practice Address - Street 1:158 E MAIN ST
Practice Address - Street 2:FREED-HARDEMAN UNIVERSITY
Practice Address - City:HENDERSON
Practice Address - State:TN
Practice Address - Zip Code:38340-2306
Practice Address - Country:US
Practice Address - Phone:731-989-6046
Practice Address - Fax:731-983-3117
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000000852255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer