Provider Demographics
NPI:1275642845
Name:MCDOUGALL, MALCOM JAMES (PT)
Entity type:Individual
Prefix:MR
First Name:MALCOM
Middle Name:JAMES
Last Name:MCDOUGALL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 JOHNSTON ST SE STE 200
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-2515
Mailing Address - Country:US
Mailing Address - Phone:256-350-1764
Mailing Address - Fax:
Practice Address - Street 1:133 RACETRACK RD NW STE B
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547
Practice Address - Country:US
Practice Address - Phone:850-344-7500
Practice Address - Fax:850-332-0666
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT008957225100000X
SC3835225100000X
FLPT34797225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPT008957OtherSTATE LICENSE
FLPT34797OtherSTATE LICENSE
SC3835OtherLICENSE #