Provider Demographics
NPI:1841689825
Name:MURRAY, MICHELE KELLY (PT, DPT)
Entity type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:KELLY
Last Name:MURRAY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:MS
Other - First Name:MICHELE
Other - Middle Name:KELLY
Other - Last Name:GRIECO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:560 WALT WHITMAN RD
Mailing Address - Street 2:STE 1
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-2114
Mailing Address - Country:US
Mailing Address - Phone:631-923-2288
Mailing Address - Fax:
Practice Address - Street 1:900 WALT WHITMAN RD
Practice Address - Street 2:STE 310
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-2215
Practice Address - Country:US
Practice Address - Phone:631-923-2288
Practice Address - Fax:631-714-6142
Is Sole Proprietor?:No
Enumeration Date:2015-01-14
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038447174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04317924Medicaid