| Doctor Name: | MR. MICHAEL BRIAN MCCORMICK |
| NPI Number: | 1487616686 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MA, ATC |
| License Number: | 2255A2300X |
| Business Practice Address: | 101 South St Vernon, CT - 060664410 |
| Business Phone Number: | 4129564888 |
| Business Fax Number: | |
| Mailing Address: | 101 South St, VERNON |
| State: | CT |
| Postal Code: | 060664434 |
| Phone Number: | 4129564888 |
| Fax Number: | |
| NPI Enumeration Date: | 04/04/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225500000X |
| License Number: | 2255A2300X |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CT |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Specialist/Technologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | General classification identifying individuals who are trained on a specific piece of equipment or technical procedure. |