Provider Demographics
NPI:1629153986
Name:MACDONALD, LORNE T (DPT)
Entity Type:Individual
Prefix:
First Name:LORNE
Middle Name:T
Last Name:MACDONALD
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4003 N WEBER ST
Mailing Address - Street 2:UNIT I
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-4410
Mailing Address - Country:US
Mailing Address - Phone:719-344-9497
Mailing Address - Fax:719-358-6042
Practice Address - Street 1:4003 N WEBER ST
Practice Address - Street 2:UNIT I
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-4410
Practice Address - Country:US
Practice Address - Phone:719-344-9497
Practice Address - Fax:719-358-6042
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7832225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO532258Medicare ID - Type Unspecified