Healthcare Provider Details

I. General information

NPI: 1093630923
Provider Name (Legal Business Name): MICHAEL DEMKO
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 CANAL ST
MILLBURY MA
01527-3253
US

IV. Provider business mailing address

21 CONSTITUTION WAY
UXBRIDGE MA
01569-0319
US

V. Phone/Fax

Practice location:
  • Phone: 508-581-8703
  • Fax:
Mailing address:
  • Phone: 508-505-5113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL89654
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: