MEDICARE: DENISE MCVAY MPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	012821	NY

General Provider Information

NPI Number	:	1508810003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE MCVAY MPT

Provider Business Mailing Address
First Line	:	26 CONKEY AVE
Second Line	:	BOX 136
City	:	NORWICH
State	:	NY
Zip	:	13815-1756
Country	:	US
Telephone Number	:	315-895-4016
Fax Number	:	315-894-7326

Provider Business Practice Location Address
First Line	:	33 CENTRAL PLZ
Second Line	:
City	:	ILION
State	:	NY
Zip	:	13357-1701
Country	:	US
Telephone Number	:	315-895-4016
Fax Number	:	315-894-7326

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	08/20/2013

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