Provider Demographics
NPI:1417083718
Name:MCDONALD, MARILYN MAILHOT (PT)
Entity type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:MAILHOT
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14480 CHAMY DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-7313
Mailing Address - Country:US
Mailing Address - Phone:775-741-3655
Mailing Address - Fax:775-851-1908
Practice Address - Street 1:14480 CHAMY DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-7313
Practice Address - Country:US
Practice Address - Phone:775-741-3655
Practice Address - Fax:775-851-1908
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV07692251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics