Provider Demographics
NPI:1427083377
Name:MCDONALD, SANDRA ANN (PT)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:ANN
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:ANN
Other - Last Name:SELE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 489
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72115-0489
Mailing Address - Country:US
Mailing Address - Phone:501-753-5189
Mailing Address - Fax:501-753-0255
Practice Address - Street 1:505 W PERSHING BLVD
Practice Address - Street 2:SUITE D.
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114-2147
Practice Address - Country:US
Practice Address - Phone:501-753-5189
Practice Address - Fax:501-753-0255
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1424225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5T638Medicare ID - Type Unspecified