Provider Demographics
NPI:1548577760
Name:MACDONALD, CAYLEY JANE (MA/RPT)
Entity Type:Individual
Prefix:
First Name:CAYLEY
Middle Name:JANE
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:MA/RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 GRANDVIEW
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92603-0222
Mailing Address - Country:US
Mailing Address - Phone:949-748-7282
Mailing Address - Fax:
Practice Address - Street 1:16269 LAGUNA CANYON RD
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3603
Practice Address - Country:US
Practice Address - Phone:949-788-9236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-09
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT63482251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics