Provider Demographics
NPI:1346378759
Name:MCCORMACK, MARYANN ELIZABETH (MSPT)
Entity type:Individual
Prefix:MRS
First Name:MARYANN
Middle Name:ELIZABETH
Last Name:MCCORMACK
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 LONGVIEW DR
Mailing Address - Street 2:
Mailing Address - City:EAST QUOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11942-3611
Mailing Address - Country:US
Mailing Address - Phone:631-653-4214
Mailing Address - Fax:
Practice Address - Street 1:1 LONGVIEW DR
Practice Address - Street 2:
Practice Address - City:EAST QUOGUE
Practice Address - State:NY
Practice Address - Zip Code:11942-3611
Practice Address - Country:US
Practice Address - Phone:631-653-4214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002358225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist