Provider Demographics
NPI:1346206943
Name:PICCIRILLO, MICHAEL J (MSPT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:PICCIRILLO
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3497
Mailing Address - Street 2:
Mailing Address - City:STURTEVANT
Mailing Address - State:WI
Mailing Address - Zip Code:53177-0300
Mailing Address - Country:US
Mailing Address - Phone:877-552-2996
Mailing Address - Fax:866-245-8064
Practice Address - Street 1:6565 E GREENWAY PARKWAY
Practice Address - Street 2:SUITE 100A
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254
Practice Address - Country:US
Practice Address - Phone:866-301-3347
Practice Address - Fax:480-483-1752
Is Sole Proprietor?:No
Enumeration Date:2006-04-22
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5084225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ488339Medicaid
AZ82522Medicare ID - Type Unspecified
AZ80026Medicare ID - Type Unspecified