Provider Demographics
NPI:1003169871
Name:POWERS, MICHAEL (ATC, EMT, CSCS)
Entity Type:Individual
Prefix:PROF
First Name:MICHAEL
Middle Name:
Last Name:POWERS
Suffix:
Gender:M
Credentials:ATC, EMT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 ROUTE 9G
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12538-2074
Mailing Address - Country:US
Mailing Address - Phone:540-336-0166
Mailing Address - Fax:
Practice Address - Street 1:3399 NORTH RD
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-1350
Practice Address - Country:US
Practice Address - Phone:845-575-3912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0018402255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer