Organization
MCDONALD REHAB, PC
Active
Other names
Superior Physical Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BART W MCDONALD MPT (OWNER)
(208) 233-2248
Entity
Organization
Contact information
Practice address
1800 FLANDRO DR, SUITE 190, POCATELLO, ID 83202-4940
(208) 233-2248
(208) 233-0219
Mailing address
1800 FLANDRO DR, SUITE 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
225X00000X
Occupational Therapist
OT-884
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7869690
AETNA
KY
05
—
807980200
—
ID
01
—
P00320548
BLUE SHIELD MEDICARE ADVA
ID
01
—
T9345
BCID
ID
Enumeration date
08/22/2007
Last updated
09/10/2015
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