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General NPI Number Information
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NPI Number | 1730422981
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Entity Type | Individual
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Provider Name | MICHAEL MCCRISTALL ATC, NSCA-CPT
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Gender | Male
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Dates
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Enumeration Date | 04/05/2013
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Last Update Date | 04/05/2013
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Provider Practice Location Address
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Address Line | 3272 HEMPSTEAD TPKE
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City | LEVITTOWN
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State | NY
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Zip | 11756-1345
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Country | US
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Telephone | 516-731-1980
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Fax |
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Provider Business Mailing Address
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Address Line | 130 S PLAISTED AVE
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City | HAUPPAUGE
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State | NY
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Zip | 11788-2754
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Country | US
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Telephone | 631-889-0303
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Fax |
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 001915
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License Number State | NY
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