Provider Demographics
NPI:1184972879
Name:METRO SPORTS PHYSICAL THERAPY PC
Entity type:Organization
Organization Name:METRO SPORTS PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CORMICAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-742-4222
Mailing Address - Street 1:401 FRANKLIN AVE
Mailing Address - Street 2:SUITE 109
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-5942
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:401 FRANKLIN AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-5942
Practice Address - Country:US
Practice Address - Phone:516-742-4222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:METRO SPORTS PHYSICAL THERAPY PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-28
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy