Provider Demographics
NPI:1710003215
Name:MCDONOUGH, THOMAS J (MT)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:MCDONOUGH
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-7310
Mailing Address - Country:US
Mailing Address - Phone:978-258-3783
Mailing Address - Fax:
Practice Address - Street 1:820 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-7310
Practice Address - Country:US
Practice Address - Phone:978-258-3783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist