Provider Demographics
NPI:1194912303
Name:MCDONALD, KERRI (MSPT)
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 E CENTER ST
Mailing Address - Street 2:
Mailing Address - City:WEST BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02379-1824
Mailing Address - Country:US
Mailing Address - Phone:508-559-0993
Mailing Address - Fax:
Practice Address - Street 1:322 E CENTER ST
Practice Address - Street 2:
Practice Address - City:WEST BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02379-1824
Practice Address - Country:US
Practice Address - Phone:508-565-5070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-02
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15246225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA496844OtherTUFTS
MA0323519Medicaid
MAY68737OtherBLUECROSS BLUESHIELD