Provider Demographics
NPI:1497447346
Name:MACDONALD, MATTHEW TIMOTHY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:TIMOTHY
Last Name:MACDONALD
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 ANN ST
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-6200
Mailing Address - Country:US
Mailing Address - Phone:860-687-9700
Mailing Address - Fax:
Practice Address - Street 1:37 ANN ST
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-6200
Practice Address - Country:US
Practice Address - Phone:860-687-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT012812225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist