Provider Demographics
NPI:1124230164
Name:MCKAY, MYRIAM CROCE (PT)
Entity Type:Individual
Prefix:MS
First Name:MYRIAM
Middle Name:CROCE
Last Name:MCKAY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 CHRISTOPHER WAY
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-1703
Mailing Address - Country:US
Mailing Address - Phone:650-498-4148
Mailing Address - Fax:650-725-5433
Practice Address - Street 1:920 CHRISTOPHER WAY
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-1703
Practice Address - Country:US
Practice Address - Phone:650-498-4148
Practice Address - Fax:650-725-5433
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18470225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist