Provider Demographics
NPI:1942464714
Name:DEFEO, MICHAEL ROBERT (DPT)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ROBERT
Last Name:DEFEO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1325 FRANKLIN AVE STE LL105
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-1688
Mailing Address - Country:US
Mailing Address - Phone:516-280-8811
Mailing Address - Fax:516-280-8809
Practice Address - Street 1:1325 FRANKLIN AVE STE LL105
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-1688
Practice Address - Country:US
Practice Address - Phone:516-280-8811
Practice Address - Fax:516-280-8809
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0303872251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic