Provider Demographics
NPI:1528315140
Name:MCDONALD, CAROL A (LPTA)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1132
Mailing Address - Street 2:54 POND STREET
Mailing Address - City:DOUGLAS
Mailing Address - State:MA
Mailing Address - Zip Code:01516-1132
Mailing Address - Country:US
Mailing Address - Phone:508-873-6399
Mailing Address - Fax:
Practice Address - Street 1:54 POND STREET ,
Practice Address - Street 2:BOX1132
Practice Address - City:DOUGLAS
Practice Address - State:MA
Practice Address - Zip Code:01516-1132
Practice Address - Country:US
Practice Address - Phone:508-873-6399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA239225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant