Provider Demographics
NPI:1093257370
Name:PLAISANCE, MICHAEL (ATC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:PLAISANCE
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 TIBBITS AVE
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-3632
Mailing Address - Country:US
Mailing Address - Phone:802-733-8837
Mailing Address - Fax:
Practice Address - Street 1:1182 TROY SCHENECTADY RD
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-1001
Practice Address - Country:US
Practice Address - Phone:518-713-5400
Practice Address - Fax:518-713-5401
Is Sole Proprietor?:No
Enumeration Date:2016-11-17
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0038632255A2300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program