Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 1932 | OR |
NPI | 1184847535 |
---|---|
Provider Name | Timothy John Mcdonald |
First Address | Eugene, OR 97405-1233 |
Second Address | Eugene, OR 97403-1205 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2007 |
Last Update Date | 08/07/2007 |