Healthcare Provider Details

I. General information

NPI: 1285693853
Provider Name (Legal Business Name): MICHAEL WALTER MCCRAIN M.S.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 MONTAUK HWY STE 109
MORICHES NY
11955-1411
US

IV. Provider business mailing address

225 MONTAUK HWY STE 109
MORICHES NY
11955-1411
US

V. Phone/Fax

Practice location:
  • Phone: 516-991-3076
  • Fax: 631-234-3077
Mailing address:
  • Phone: 516-991-3076
  • Fax: 631-234-3077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number026830-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number026830-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number026830-1
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number026830-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: