Provider Demographics
NPI:1225055122
Name:MCVAY, JEREMY JAY (DPT)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:JAY
Last Name:MCVAY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 MAPLE AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:RI
Mailing Address - Zip Code:02806-3561
Mailing Address - Country:US
Mailing Address - Phone:401-643-1776
Mailing Address - Fax:401-694-0965
Practice Address - Street 1:18 MAPLE AVE STE 1
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:RI
Practice Address - Zip Code:02806-3561
Practice Address - Country:US
Practice Address - Phone:401-643-1776
Practice Address - Fax:401-694-0965
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16305225100000X
RIPT01685225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI007010458Medicare ID - Type Unspecified