Provider Demographics
NPI:1760141295
Name:YORK, MICHAELA LYNN (PT)
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:LYNN
Last Name:YORK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MICHAELA
Other - Middle Name:LYNN
Other - Last Name:MAYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:5849 E CIRCLE DR STE B
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:NY
Mailing Address - Zip Code:13039-8654
Mailing Address - Country:US
Mailing Address - Phone:315-635-5000
Mailing Address - Fax:315-458-2975
Practice Address - Street 1:5849 E CIRCLE DR STE B
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:NY
Practice Address - Zip Code:13039-8654
Practice Address - Country:US
Practice Address - Phone:315-635-5000
Practice Address - Fax:315-458-2975
Is Sole Proprietor?:No
Enumeration Date:2021-12-13
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048299225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06887838Medicaid