Healthcare Provider Details

I. General information

NPI: 1245278241
Provider Name (Legal Business Name): MICHAEL MCCRAIN MSPT CSCS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 06/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 MONTAUK HWY SUITE 109
MORICHES NY
11955-1425
US

IV. Provider business mailing address

225 MONTAUK HWY SUITE 109
MORICHES NY
11955-1425
US

V. Phone/Fax

Practice location:
  • Phone: 631-878-7012
  • Fax: 631-878-7015
Mailing address:
  • Phone: 631-878-7012
  • Fax: 631-878-7015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL W MCCRAIN
Title or Position: PHYSICAL THERAPIST
Credential: MSPT
Phone: 631-878-7012