Provider Demographics
NPI:1811149206
Name:PIERCEY, MICHAEL T (DPT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:T
Last Name:PIERCEY
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 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1000 SMYRNA CLAYTON BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:SMYRNA
Practice Address - State:DE
Practice Address - Zip Code:19977-2228
Practice Address - Country:US
Practice Address - Phone:302-659-3102
Practice Address - Fax:302-653-5423
Is Sole Proprietor?:No
Enumeration Date:2008-10-16
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22700225100000X
DEJ1-0002397225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
3553587000OtherIBC AMERIHEALTH
MD136940ZBL8Medicare PIN