Provider Demographics
NPI:1962668913
Name:GOLISANO, MICHAEL CRAIG (DPT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CRAIG
Last Name:GOLISANO
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 1:161 E COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:EAST ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14445-1726
Mailing Address - Country:US
Mailing Address - Phone:585-218-0240
Mailing Address - Fax:
Practice Address - Street 1:161 E COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:EAST ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14445-1726
Practice Address - Country:US
Practice Address - Phone:585-218-0240
Practice Address - Fax:585-218-0245
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-30
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030453225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist