Provider Demographics
NPI:1285683151
Name:MCDONALD, TINA MARIE (RPT)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:MARIE
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:MARIE
Other - Last Name:TEIXEIRA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPT
Mailing Address - Street 1:210 COMMERCE WAY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-8200
Mailing Address - Country:US
Mailing Address - Phone:207-439-2675
Mailing Address - Fax:207-439-4965
Practice Address - Street 1:1150 HALL OF FAME AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01105-2514
Practice Address - Country:US
Practice Address - Phone:413-241-8900
Practice Address - Fax:413-241-8901
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007835225100000X
MA17528225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist