Provider Demographics
NPI:1801981808
Name:MARK MCDONALD P.T., P.C.
Entity type:Organization
Organization Name:MARK MCDONALD P.T., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:DPT,OCS
Authorized Official - Phone:970-522-7743
Mailing Address - Street 1:427 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:CO
Mailing Address - Zip Code:80751-3033
Mailing Address - Country:US
Mailing Address - Phone:970-522-7743
Mailing Address - Fax:970-522-8835
Practice Address - Street 1:427 W MAIN ST
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:CO
Practice Address - Zip Code:80751-3033
Practice Address - Country:US
Practice Address - Phone:970-522-7743
Practice Address - Fax:970-522-8835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0229266225X00000X, 235Z00000X, 225100000X, 225X00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000180905Medicaid
COMAP6403OtherBLUE CROSS/BLUE SHIELD
KS05974OtherBLUE CROSS/BLUE SHIELD
COMAP6403OtherBLUE CROSS/BLUE SHIELD
KS176557Medicare ID - Type UnspecifiedMEDICARE