Basic Information
| Provider Information | |||||||||
| NPI: | 1073000600 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SWEENEY | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | JOHN | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 990 PEACHTREE INDUSTRIAL BLVD UNIT 101 | ||||||||
| Address2: | |||||||||
| City: | SUWANEE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300245201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8338887868 | ||||||||
| FaxNumber: | 8338887868 | ||||||||
| Practice Location | |||||||||
| Address1: | 890 ROUTE 35 | ||||||||
| Address2: | |||||||||
| City: | CROSS RIVER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105181139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9147635941 | ||||||||
| FaxNumber: | 9147635332 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2018 | ||||||||
| LastUpdateDate: | 04/19/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 020568 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.