Provider Demographics
NPI:1912126822
Name:MCDONALD, SABRA MICHELLE (PT)
Entity Type:Individual
Prefix:MRS
First Name:SABRA
Middle Name:MICHELLE
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:SABRA
Other - Middle Name:M
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:7111 PHEASANT RD
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-4303
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6601 MADISON AVE
Practice Address - Street 2:STE 200
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-0600
Practice Address - Country:US
Practice Address - Phone:916-965-8900
Practice Address - Fax:916-965-9630
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT26995225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT26995OtherBLUE SHIELD OF CALIFORNIA