Provider Demographics
NPI:1508032764
Name:MACDOUGALL WALTER, MICHELE ANNE (PT)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:ANNE
Last Name:MACDOUGALL WALTER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:MICHELE
Other - Middle Name:A
Other - Last Name:MACDOUGALL WALTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:6887 FARRINGTON HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:CHERRY CREEK
Mailing Address - State:NY
Mailing Address - Zip Code:14723-9735
Mailing Address - Country:US
Mailing Address - Phone:716-785-2858
Mailing Address - Fax:
Practice Address - Street 1:50 E NORTH ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-1002
Practice Address - Country:US
Practice Address - Phone:716-885-8318
Practice Address - Fax:716-885-0229
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011141225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist