Provider Demographics
NPI:1982632576
Name:MCINTOSH, MICHAEL DANA (PT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DANA
Last Name:MCINTOSH
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 1:14899 TAMIAMI TRL STE 200
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34287-2732
Mailing Address - Country:US
Mailing Address - Phone:561-688-1844
Mailing Address - Fax:561-688-1845
Practice Address - Street 1:14899 TAMIAMI TRL STE 200
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287-2732
Practice Address - Country:US
Practice Address - Phone:561-688-1844
Practice Address - Fax:561-688-1845
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004015329225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100982700Medicaid