Provider Demographics
NPI:1306987284
Name:MCCORMICK, JEFFERY P (MSPT)
Entity type:Individual
Prefix:
First Name:JEFFERY
Middle Name:P
Last Name:MCCORMICK
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 1:1340 LAKE BLVD
Mailing Address - Street 2:SUTTER PHYSICAL AND HAND THERAPY
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-2619
Mailing Address - Country:US
Mailing Address - Phone:530-753-5338
Mailing Address - Fax:530-753-4609
Practice Address - Street 1:1340 LAKE BLVD
Practice Address - Street 2:SUTTER PHYSICAL AND HAND THERAPY
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-2619
Practice Address - Country:US
Practice Address - Phone:530-753-5338
Practice Address - Fax:530-753-4609
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17821225100000X
CAPT34210225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1467437657OtherREBOUND'S NPI
MA1467437657OtherHCVM
MA1467437657OtherUNICARE
MA1467437657OtherUNITED
MA1467437657OtherCCN
MA1467437657OtherCOMM INDEMNITY
MA1467437657OtherPHCS
MAAA45429OtherHP
MA1467437657OtherAETNA
MA1467437657OtherOXFORD
MA1467437657OtherTRICARE
MA621300OtherTUFTS
MA8077207OtherCIGNA
MAREPT0299OtherMEDICARE