Provider Demographics
NPI:1225098544
Name:GARRETT, MICHAEL ROGER (MSC HONS PT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ROGER
Last Name:GARRETT
Suffix:
Gender:M
Credentials:MSC HONS PT
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Mailing Address - Street 1:23 W CHESTER ST
Mailing Address - Street 2:APARTMENT 5
Mailing Address - City:NANTUCKET
Mailing Address - State:MA
Mailing Address - Zip Code:02554-3680
Mailing Address - Country:US
Mailing Address - Phone:508-680-1276
Mailing Address - Fax:508-608-1427
Practice Address - Street 1:23 W CHESTER ST
Practice Address - Street 2:APARTMENT 5
Practice Address - City:NANTUCKET
Practice Address - State:MA
Practice Address - Zip Code:02554-3680
Practice Address - Country:US
Practice Address - Phone:508-680-1276
Practice Address - Fax:508-680-1427
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2009-10-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA174682251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA650041OtherTUFTS
MA17468OtherMEDICAL LICENSE
MAY68819OtherBLUE CROSS OF MA
CO7261OtherMEDICAL LICENSE
MAY68819OtherBLUE CROSS OF MA