Provider Demographics
NPI:1184847535
Name:MCDONALD, TIMOTHY JOHN (PT, ATC)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:JOHN
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2961 TIMBERLINE DR
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-1233
Mailing Address - Country:US
Mailing Address - Phone:541-343-6346
Mailing Address - Fax:
Practice Address - Street 1:1232 UNIVERSITY OF OREGON
Practice Address - Street 2:UNIVERSITY OF OREGON STUDENT HEALTH CENTER
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97403-1205
Practice Address - Country:US
Practice Address - Phone:541-346-2725
Practice Address - Fax:541-346-2747
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR19322251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports