Provider Demographics
NPI:1487616686
Name:MCCORMICK, MICHAEL BRIAN (MA, ATC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:BRIAN
Last Name:MCCORMICK
Suffix:
Gender:M
Credentials:MA, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-4434
Mailing Address - Country:US
Mailing Address - Phone:412-956-4888
Mailing Address - Fax:
Practice Address - Street 1:101 SOUTH ST
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-4410
Practice Address - Country:US
Practice Address - Phone:412-956-4888
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2255A2300X225500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist