Provider Demographics
NPI:1073000600
Name:SWEENEY, MICHAEL JOHN (DPT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOHN
Last Name:SWEENEY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:990 PEACHTREE INDUSTRIAL BLVD UNIT 101
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-5201
Mailing Address - Country:US
Mailing Address - Phone:833-888-7868
Mailing Address - Fax:833-888-7868
Practice Address - Street 1:890 ROUTE 35
Practice Address - Street 2:
Practice Address - City:CROSS RIVER
Practice Address - State:NY
Practice Address - Zip Code:10518-1139
Practice Address - Country:US
Practice Address - Phone:914-763-5941
Practice Address - Fax:914-763-5332
Is Sole Proprietor?:No
Enumeration Date:2018-04-19
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020568225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist