Provider Demographics
NPI:1720202799
Name:MCDONALD, JENNIFER STITT (PT, DPT, MS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:STITT
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:PT, DPT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 CASTLE DR
Mailing Address - Street 2:
Mailing Address - City:POTSDAM
Mailing Address - State:NY
Mailing Address - Zip Code:13676-1610
Mailing Address - Country:US
Mailing Address - Phone:315-268-9096
Mailing Address - Fax:
Practice Address - Street 1:59 MAIN ST
Practice Address - Street 2:CENTER FOR HEALTH SCIENCES
Practice Address - City:POTSDAM
Practice Address - State:NY
Practice Address - Zip Code:13676-2148
Practice Address - Country:US
Practice Address - Phone:315-261-5460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010215-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist