Provider Demographics
NPI:1831276500
Name:MCKAY, JAMES BERNARD (PT)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:BERNARD
Last Name:MCKAY
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 1:31 OLD ROUTE 7
Mailing Address - Street 2:ATTN CREDENTIALING DEPT
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-1714
Mailing Address - Country:US
Mailing Address - Phone:203-740-0020
Mailing Address - Fax:203-775-0238
Practice Address - Street 1:20 GERMANTOWN RD
Practice Address - Street 2:SUITE 102
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-5023
Practice Address - Country:US
Practice Address - Phone:203-778-4773
Practice Address - Fax:203-778-4774
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT650001352Medicare PIN