Provider Demographics
NPI:1790098283
Name:MCDONALD, ASHLEY RAE (DPT)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:RAE
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 CAMPUS DR
Mailing Address - Street 2:113 SKAGGS BLDG, UNIVERSITY OF MONTANA
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59812-0003
Mailing Address - Country:US
Mailing Address - Phone:406-243-6120
Mailing Address - Fax:406-243-2795
Practice Address - Street 1:32 CAMPUS DR
Practice Address - Street 2:113 SKAGGS BLDG, UNIVERSITY OF MONTANA
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59812-0003
Practice Address - Country:US
Practice Address - Phone:406-243-6120
Practice Address - Fax:406-243-2795
Is Sole Proprietor?:No
Enumeration Date:2010-07-26
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6239225100000X
MT2387225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR154693Medicare PIN