Provider Demographics
NPI:1285693853
Name:MCCRAIN, MICHAEL WALTER (MSPT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:WALTER
Last Name:MCCRAIN
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 MONTAUK HWY
Mailing Address - Street 2:STE 109
Mailing Address - City:MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11955-1411
Mailing Address - Country:US
Mailing Address - Phone:516-991-3076
Mailing Address - Fax:631-234-3077
Practice Address - Street 1:225 MONTAUK HWY
Practice Address - Street 2:STE 109
Practice Address - City:MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11955-1411
Practice Address - Country:US
Practice Address - Phone:516-991-3076
Practice Address - Fax:631-234-3077
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026830-1225100000X, 2251G0304X, 2251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
Not Answered2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Not Answered2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ6WN41Medicare ID - Type Unspecified