Provider Demographics
NPI:1932117934
Name:DONALDSON, MATTHEW MACGREGOR (PT)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:MACGREGOR
Last Name:DONALDSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1223 CAVANAUGH WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95822
Mailing Address - Country:US
Mailing Address - Phone:916-541-2633
Mailing Address - Fax:
Practice Address - Street 1:1308 28TH ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816
Practice Address - Country:US
Practice Address - Phone:916-446-1497
Practice Address - Fax:916-446-5959
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT30260225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OPT302600Medicare ID - Type Unspecified