Provider Demographics
NPI:1235221359
Name:MAYKISH, RICHARD J (PT)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:J
Last Name:MAYKISH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:287 TRACY RD
Mailing Address - Street 2:
Mailing Address - City:SHERBURNE
Mailing Address - State:NY
Mailing Address - Zip Code:13460-2619
Mailing Address - Country:US
Mailing Address - Phone:600-742-8033
Mailing Address - Fax:
Practice Address - Street 1:287 TRACY RD
Practice Address - Street 2:
Practice Address - City:SHERBURNE
Practice Address - State:NY
Practice Address - Zip Code:13460-2619
Practice Address - Country:US
Practice Address - Phone:607-674-6262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025055225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist