Provider Demographics
NPI:1992056204
Name:MACDONALD, CARA MARIE (PT)
Entity type:Individual
Prefix:
First Name:CARA
Middle Name:MARIE
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CARA
Other - Middle Name:MARIE
Other - Last Name:GARUCCIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2551 SUMMIT RIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-8700
Mailing Address - Country:US
Mailing Address - Phone:434-466-3110
Mailing Address - Fax:
Practice Address - Street 1:5690 THREE NOTCH D RD
Practice Address - Street 2:
Practice Address - City:CROZET
Practice Address - State:VA
Practice Address - Zip Code:22932-3172
Practice Address - Country:US
Practice Address - Phone:434-823-7628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305203828225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist