Individual
BART WILLIAM MCDONALD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MPT
Contact information
Practice address
1800 FLANDRO DR, 190, POCATELLO, ID 83202-4940
(208) 233-2248
(208) 233-0219
Mailing address
1800 FLANDRO DR, 190, POCATELLO, ID 83202-4940
(208) 233-2248
(208) 233-0219
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-1555
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5744703
FIRST HEALTH
ID
05
—
807400900
—
ID
01
—
P00320548
BLUE SHIELD MEDICARE ADV
ID
01
—
PT1555
TRICARE
ID
01
—
TD646
BCID
ID
Enumeration date
04/04/2007
Last updated
03/30/2010
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