Provider Demographics
NPI:1588620264
Name:MCDONALD, AMY LOUISE (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LOUISE
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:MISS
Other - First Name:AMY
Other - Middle Name:LOUISE
Other - Last Name:MANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:2935 HEALTH PKWY
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-8931
Mailing Address - Country:US
Mailing Address - Phone:989-772-1609
Mailing Address - Fax:989-953-4949
Practice Address - Street 1:2935 HEALTH PKWY
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-8931
Practice Address - Country:US
Practice Address - Phone:989-772-1609
Practice Address - Fax:989-953-4949
Is Sole Proprietor?:No
Enumeration Date:2006-04-22
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010904225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P82773Medicare UPIN
ON95180Medicare ID - Type Unspecified