Provider Demographics
NPI:1104000264
Name:VERESH, MICHAEL (PT, DPT, OMPT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:VERESH
Suffix:
Gender:M
Credentials:PT, DPT, OMPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1327 E WASHINGTON AVE
Mailing Address - Street 2:PMB132
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-5684
Mailing Address - Country:US
Mailing Address - Phone:956-428-5440
Mailing Address - Fax:
Practice Address - Street 1:864 CENTRAL BLVD
Practice Address - Street 2:STE 3200
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-7551
Practice Address - Country:US
Practice Address - Phone:956-542-2845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-26
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12052932251X0800X
MI5501013568225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1528096963OtherNPI
0C360680Medicare PIN