Provider Demographics
NPI:1518097781
Name:MCCORMACK, MAIRE BRIGID (RPT)
Entity Type:Individual
Prefix:MS
First Name:MAIRE
Middle Name:BRIGID
Last Name:MCCORMACK
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 BEACH DR NE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33704-4815
Mailing Address - Country:US
Mailing Address - Phone:727-821-2700
Mailing Address - Fax:
Practice Address - Street 1:1505 BEACH DR NE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33704-4815
Practice Address - Country:US
Practice Address - Phone:727-821-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT9098225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist