Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 026830-1 | NY |
N | 2251G0304X | Physical Therapist - Geriatrics | 026830-1 | NY |
N | 2251S0007X | Physical Therapist - Sports | 026830-1 | NY |
N | 2251X0800X | Physical Therapist - Orthopedic | 026830-1 | NY |
NPI | 1285693853 |
---|---|
Provider Name | Mr. Michael Walter Mccrain |
First Address | Moriches, NY 11955-1411 |
Second Address | Moriches, NY 11955-1411 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2006 |
Last Update Date | 08/07/2007 |