Provider Demographics
NPI:1629225453
Name:MCDONALD, JOY ARLENE (PTA, LMT)
Entity Type:Individual
Prefix:MS
First Name:JOY
Middle Name:ARLENE
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:PTA, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8145 CAMPBELL CT
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34653-2435
Mailing Address - Country:US
Mailing Address - Phone:727-514-4680
Mailing Address - Fax:
Practice Address - Street 1:8145 CAMPBELL CT
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653-2435
Practice Address - Country:US
Practice Address - Phone:727-514-4680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-22
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA19327172V00000X
FLMA46770172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker