Provider Demographics
NPI:1194243691
Name:MCDONALD REHAB, PC
Entity type:Organization
Organization Name:MCDONALD REHAB, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BART
Authorized Official - Middle Name:W
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:208-233-2248
Mailing Address - Street 1:1800 FLANDRO DR STE 190
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83202-4940
Mailing Address - Country:US
Mailing Address - Phone:208-233-2248
Mailing Address - Fax:208-233-0219
Practice Address - Street 1:3345 POTOMAC WAY STE B
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-4978
Practice Address - Country:US
Practice Address - Phone:208-417-0090
Practice Address - Fax:208-417-0092
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MCDONALD REHAB, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-09-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty