Provider Demographics
NPI:1366066284
Name:MACDONALD, APRIL
Entity type:Individual
Prefix:
First Name:APRIL
Middle Name:
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10656 W COOK RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46818-9452
Mailing Address - Country:US
Mailing Address - Phone:260-415-8528
Mailing Address - Fax:
Practice Address - Street 1:200 KINGSTON CIR
Practice Address - Street 2:
Practice Address - City:LIGONIER
Practice Address - State:IN
Practice Address - Zip Code:46767-9771
Practice Address - Country:US
Practice Address - Phone:260-894-7131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-05
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist