Provider Demographics
NPI:1598805897
Name:MACDONALD, GAIL KELLEY (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:KELLEY
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 PLATINUM PT
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-4871
Mailing Address - Country:US
Mailing Address - Phone:407-206-4590
Mailing Address - Fax:407-206-4591
Practice Address - Street 1:701 PLATINUM PT
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-4871
Practice Address - Country:US
Practice Address - Phone:407-206-4590
Practice Address - Fax:407-206-4591
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT22392225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL891572500Medicaid