Individual
MICHELLE RENEE MACDONALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.P.T.
Contact information
Practice address
1159 MAIN ST, SUITE A, WINDSOR, CO 80550-4700
(970) 460-0066
(970) 460-0136
Mailing address
1307 E PROSPECT RD STE 120, FORT COLLINS, CO 80525-1191
(970) 460-0066
(970) 460-0136
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
9941
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
COB4918
MEDICARE GROUP PTAN
CO
Enumeration date
08/30/2006
Last updated
10/27/2017
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