Provider Demographics
NPI:1396957767
Name:MACDONALD, CAMERON W (PT DPT)
Entity type:Individual
Prefix:DR
First Name:CAMERON
Middle Name:W
Last Name:MACDONALD
Suffix:
Gender:M
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:9480 BRIAR VILLAGE PT
Mailing Address - Street 2:SUITE #201
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-7922
Mailing Address - Country:US
Mailing Address - Phone:719-266-1788
Mailing Address - Fax:719-264-7706
Practice Address - Street 1:9480 BRIAR VILLAGE PT
Practice Address - Street 2:SUITE #201
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7922
Practice Address - Country:US
Practice Address - Phone:719-266-1788
Practice Address - Fax:719-264-7706
Is Sole Proprietor?:No
Enumeration Date:2007-05-05
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7716225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist