Provider Demographics
NPI:1629853916
Name:OVERLY, MICHAEL HENRY PAPICA (PT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL HENRY
Middle Name:PAPICA
Last Name:OVERLY
Suffix:
Gender:M
Credentials:PT
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Mailing Address - Street 1:542 VAN SICLEN AVE # 2R
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11207-5631
Mailing Address - Country:US
Mailing Address - Phone:347-362-1198
Mailing Address - Fax:
Practice Address - Street 1:12073 FLATLANDS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-8306
Practice Address - Country:US
Practice Address - Phone:917-336-3171
Practice Address - Fax:718-642-9359
Is Sole Proprietor?:No
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY050882225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist