Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 007647 | CT |
NPI | 1003203415 |
---|---|
Provider Name | Mr. Douglas Scott Macdonald JR. |
First Address | Milford, CT 06460-7542 |
Second Address | Milford, CT 06460-7542 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2015 |
Last Update Date | 23/04/2015 |