Individual
NICOLE TODISCO MACDONALD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
345 SW CYBER DR STE 104, BEND, OR 97702-1045
(802) 318-2254
Mailing address
1645 NE SHEPARD RD, BEND, OR 97701-4164
(802) 318-2254
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
62809
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500744539
—
OR
Enumeration date
06/11/2018
Last updated
03/21/2022
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