Provider Demographics
NPI:1013988443
Name:MCDONALD, MAURICE L (PT)
Entity Type:Individual
Prefix:
First Name:MAURICE
Middle Name:L
Last Name:MCDONALD
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 1:1022 E GRIFFIN PKWY
Mailing Address - Street 2:STE 203
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-2400
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1022 E GRIFFIN PKWY
Practice Address - Street 2:STE 203
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-2400
Practice Address - Country:US
Practice Address - Phone:956-424-7885
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1081552225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0585028Medicaid
TX8B9012Medicare ID - Type UnspecifiedPROVIDER NUMBER