Basic Information
| Provider Information | |||||||||
| NPI: | 1396957767 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MACDONALD | ||||||||
| FirstName: | CAMERON | ||||||||
| MiddleName: | W | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | P.T D.P.T | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9480 BRIAR VILLAGE PT | ||||||||
| Address2: | SUITE #201 | ||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809207922 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7192661788 | ||||||||
| FaxNumber: | 7192647706 | ||||||||
| Practice Location | |||||||||
| Address1: | 9480 BRIAR VILLAGE PT | ||||||||
| Address2: | SUITE #201 | ||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809207922 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7192661788 | ||||||||
| FaxNumber: | 7192647706 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2007 | ||||||||
| LastUpdateDate: | 04/07/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 7716 | CO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.