Individual
KERRY R MACDONALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPT
Contact information
Practice address
4301 WILSON ST, FORT SILL, OK 73503-4472
(805) 558-3414
Mailing address
4301 WILSON ST, FORT SILL, OK 73503-4472
(580) 558-3414
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
1129815
TX
225100000X
Physical Therapist
2962
NM
225100000X
Physical Therapist
Primary
4647
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
13602012
—
NM
01
—
NM00Q469
BCBS NM
NM
Enumeration date
08/05/2006
Last updated
01/02/2024
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