Provider Demographics
NPI:1376001560
Name:MCDONALD, SIDNEY W (BS, LMT)
Entity Type:Individual
Prefix:MR
First Name:SIDNEY
Middle Name:W
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:BS, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 CRAWFORD VLG APT A
Mailing Address - Street 2:
Mailing Address - City:MCKEESPORT
Mailing Address - State:PA
Mailing Address - Zip Code:15132-1724
Mailing Address - Country:US
Mailing Address - Phone:412-654-3749
Mailing Address - Fax:
Practice Address - Street 1:25 CRAWFORD VLG APT A
Practice Address - Street 2:
Practice Address - City:MCKEESPORT
Practice Address - State:PA
Practice Address - Zip Code:15132-1724
Practice Address - Country:US
Practice Address - Phone:412-654-3749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG006385225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty