Provider Demographics
NPI:1336207000
Name:MCDONALD, BELINDA JANE (PT, COMT)
Entity type:Individual
Prefix:
First Name:BELINDA
Middle Name:JANE
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:PT, COMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1393 CALLE AVANZADO
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-6351
Mailing Address - Country:US
Mailing Address - Phone:949-481-0015
Mailing Address - Fax:949-481-5611
Practice Address - Street 1:1393 CALLE AVANZADO
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-6351
Practice Address - Country:US
Practice Address - Phone:949-481-0015
Practice Address - Fax:949-481-5611
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT26150225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19207Medicare ID - Type Unspecified