Provider Demographics
NPI:1093928400
Name:GUS, MICHAEL M (PT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:M
Last Name:GUS
Suffix:
Gender:M
Credentials:PT
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Mailing Address - Street 1:3061 STATE ROUTE 28
Mailing Address - Street 2:
Mailing Address - City:HERKIMER
Mailing Address - State:NY
Mailing Address - Zip Code:13350-1041
Mailing Address - Country:US
Mailing Address - Phone:315-717-0020
Mailing Address - Fax:
Practice Address - Street 1:5094 COMMERCIAL DR
Practice Address - Street 2:
Practice Address - City:YORKVILLE
Practice Address - State:NY
Practice Address - Zip Code:13495-1106
Practice Address - Country:US
Practice Address - Phone:315-768-8521
Practice Address - Fax:315-768-7882
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022174-12251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400029169Medicare PIN