Provider Demographics
NPI:1992115232
Name:MCDONALD, PAULA
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 MORRISSEY BLVD
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02122-3206
Mailing Address - Country:US
Mailing Address - Phone:617-506-7210
Mailing Address - Fax:617-506-1384
Practice Address - Street 1:960 MORRISSEY BLVD
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02122-3206
Practice Address - Country:US
Practice Address - Phone:617-506-7210
Practice Address - Fax:617-506-1384
Is Sole Proprietor?:No
Enumeration Date:2014-05-07
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6522225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist