Provider Demographics
NPI:1962644765
Name:GARAYGAY, MICHAEL RIVAS (PT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:RIVAS
Last Name:GARAYGAY
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 1:711 STONEWOOD BEND DR
Mailing Address - Street 2:
Mailing Address - City:LAKE ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367-4064
Mailing Address - Country:US
Mailing Address - Phone:636-265-2562
Mailing Address - Fax:636-561-0966
Practice Address - Street 1:439 S KIRKWOOD RD STE 204
Practice Address - Street 2:
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-6100
Practice Address - Country:US
Practice Address - Phone:314-822-6297
Practice Address - Fax:314-822-6288
Is Sole Proprietor?:No
Enumeration Date:2009-03-25
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008037338225100000X
IL070-008459225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist