Provider Demographics
NPI:1568098879
Name:MACDONALD, THOMAS BRIAN
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:BRIAN
Last Name:MACDONALD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7399 BAYWIND DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:OH
Mailing Address - Zip Code:45242-5810
Mailing Address - Country:US
Mailing Address - Phone:513-604-5457
Mailing Address - Fax:
Practice Address - Street 1:11305 REED HARTMAN HWY STE 226
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45241-2435
Practice Address - Country:US
Practice Address - Phone:513-563-8777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-18
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0129922251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics