Provider Demographics
NPI:1669501755
Name:O'GRADY, MICHAEL (PT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:O'GRADY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12625A LEE HWY
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22747-1931
Mailing Address - Country:US
Mailing Address - Phone:540-987-9395
Mailing Address - Fax:
Practice Address - Street 1:12625A LEE HWY
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:VA
Practice Address - Zip Code:22747-1931
Practice Address - Country:US
Practice Address - Phone:540-987-9395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305205171225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00655616Medicare PIN
VAMC10661Medicare PIN