Provider Demographics
NPI:1659761617
Name:DAGRO, MICHAEL (DPT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:DAGRO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:899 MONTAUK HWY
Mailing Address - Street 2:
Mailing Address - City:BAYPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11705-1613
Mailing Address - Country:US
Mailing Address - Phone:631-823-0600
Mailing Address - Fax:631-823-0602
Practice Address - Street 1:899 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:BAYPORT
Practice Address - State:NY
Practice Address - Zip Code:11705
Practice Address - Country:US
Practice Address - Phone:631-823-0600
Practice Address - Fax:631-823-0602
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-29
Last Update Date:2020-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038010225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400125623Medicare PIN