Provider Demographics
NPI:1295995975
Name:MCDONALD, PATTI A (MS, PT)
Entity type:Individual
Prefix:MRS
First Name:PATTI
Middle Name:A
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:980 E WATER ST
Mailing Address - Street 2:
Mailing Address - City:LOCK HAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:17745-1514
Mailing Address - Country:US
Mailing Address - Phone:570-748-3928
Mailing Address - Fax:570-748-3610
Practice Address - Street 1:980 E WATER ST
Practice Address - Street 2:
Practice Address - City:LOCK HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17745-1514
Practice Address - Country:US
Practice Address - Phone:570-748-3928
Practice Address - Fax:570-748-3610
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT010978L2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001911830OtherMA PROVIDER NUMBER