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General NPI Number Information
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NPI Number | 1588669394
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Entity Type | Individual
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Provider Name | MICHAEL A MCCORMACK MPT
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Gender | Male
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Dates
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Enumeration Date | 06/17/2005
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Last Update Date | 01/24/2014
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Provider Practice Location Address
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Address Line | 7423 S MASON MONTGOMERY RD
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City | MASON
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State | OH
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Zip | 45040-7828
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Country | US
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Telephone | 513-347-9999
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Fax | 513-573-9178
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Provider Business Mailing Address
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Address Line | 7423 S MASON MONTGOMERY RD
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City | MASON
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State | OH
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Zip | 45040-7828
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Country | US
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Telephone | 513-347-9999
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Fax | 513-573-9178
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | PT06009
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | PT002212
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License Number State | KY
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