Provider Demographics
NPI:1306199815
Name:MCDONALD, KRISTY LYNNE (LMT)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:LYNNE
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 CALDWELL DR
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-5010
Mailing Address - Country:US
Mailing Address - Phone:716-510-5192
Mailing Address - Fax:
Practice Address - Street 1:1900 RIDGE RD
Practice Address - Street 2:STE 127
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-3332
Practice Address - Country:US
Practice Address - Phone:716-677-2969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-22
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026135225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist