Provider Demographics
NPI:1417377300
Name:GAY, MICHAEL (PHD, ATC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:GAY
Suffix:
Gender:M
Credentials:PHD, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102C EAST AREA LOCKER BUILDING
Mailing Address - Street 2:PENN STATE UNIVERSITY
Mailing Address - City:UNIVERSITY PARK
Mailing Address - State:PA
Mailing Address - Zip Code:16802
Mailing Address - Country:US
Mailing Address - Phone:814-865-8296
Mailing Address - Fax:814-863-7906
Practice Address - Street 1:102C EAST AREA LOCKER BUILDING
Practice Address - Street 2:PENN STATE UNIVERSITY
Practice Address - City:UNIVERSITY PARK
Practice Address - State:PA
Practice Address - Zip Code:16802
Practice Address - Country:US
Practice Address - Phone:814-865-8296
Practice Address - Fax:814-863-7906
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-18
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0030142255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer