Provider Demographics
NPI:1417187774
Name:MACDONALD, MEAGAN RENAE (LAT/ATC)
Entity Type:Individual
Prefix:
First Name:MEAGAN
Middle Name:RENAE
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:LAT/ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 15TH AVE S
Mailing Address - Street 2:SPORTS MEDICINE
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-4304
Mailing Address - Country:US
Mailing Address - Phone:406-369-1741
Mailing Address - Fax:406-455-2626
Practice Address - Street 1:500 15TH AVE S
Practice Address - Street 2:SPORTS MEDICINE
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-4304
Practice Address - Country:US
Practice Address - Phone:406-369-1741
Practice Address - Fax:406-455-2626
Is Sole Proprietor?:No
Enumeration Date:2009-07-21
Last Update Date:2009-07-21
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer