| Doctor Name: | KELLY R MCDONOUGH |
| NPI Number: | 1336365279 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PT |
| License Number: | 5501012567 |
| Business Practice Address: | 11293 N M 37 Ste B Buckley, MI - 496209593 |
| Business Phone Number: | 2312693500 |
| Business Fax Number: | 2317233586 |
| Mailing Address: | 4153 Bridlewood Dr, TRAVERSE CITY |
| State: | MI |
| Postal Code: | 496849618 |
| Phone Number: | 2317235479 |
| Fax Number: | 2317233586 |
| NPI Enumeration Date: | 04/18/2007 |
| NPI Last Update Date: | 06/10/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 5501012567 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |