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General NPI Number Information
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NPI Number | 1073287561
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Entity Type | Individual
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Provider Name | TRISHA ANNE MCCORMACK DPT
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Gender | Female
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Dates
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Enumeration Date | 08/06/2021
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Last Update Date | 01/03/2024
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Provider Practice Location Address
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Address Line | 11275 DELAWARE PKWY STE B
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City | CROWN POINT
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State | IN
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Zip | 46307-7812
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Country | US
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Telephone | 219-663-8766
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Fax |
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Provider Business Mailing Address
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Address Line | 1311 MAMARONECK AVE STE 140
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City | WHITE PLAINS
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State | NY
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Zip | 10605-5224
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Country | US
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Telephone | 914-294-4050
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Fax | 631-760-8306
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 99106004A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 05014337A
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License Number State | IN
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