Provider Demographics
NPI:1902912736
Name:MACDONALD, IAN TODD (DPT)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:TODD
Last Name:MACDONALD
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-3010
Mailing Address - Country:US
Mailing Address - Phone:603-222-7000
Mailing Address - Fax:603-222-7011
Practice Address - Street 1:707 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-3010
Practice Address - Country:US
Practice Address - Phone:603-222-7000
Practice Address - Fax:603-222-7011
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3046225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30393812Medicaid