Provider Demographics
NPI:1053411389
Name:MCDONALD, CHRYSTAL L (MPT, DPT)
Entity type:Individual
Prefix:DR
First Name:CHRYSTAL
Middle Name:L
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:MPT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 ROCK CLIFF DR
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-2838
Mailing Address - Country:US
Mailing Address - Phone:304-267-0866
Mailing Address - Fax:304-267-8348
Practice Address - Street 1:302 ROCK CLIFF DR
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-2838
Practice Address - Country:US
Practice Address - Phone:304-267-0866
Practice Address - Fax:304-267-8348
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVPT 002284225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVMC4122151Medicare PIN