Provider Demographics
NPI:1902361199
Name:MCDONALD, MARTHA L (MSPT)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:L
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3728 OLD LODGE RD
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601-4543
Mailing Address - Country:US
Mailing Address - Phone:970-309-3378
Mailing Address - Fax:
Practice Address - Street 1:1450 E VALLEY RD UNIT 203
Practice Address - Street 2:
Practice Address - City:BASALT
Practice Address - State:CO
Practice Address - Zip Code:81621-8352
Practice Address - Country:US
Practice Address - Phone:970-927-9319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-01
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0007224225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist