Provider Demographics
NPI:1053384354
Name:CASH, MICHAEL D (PT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:CASH
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 1:792 N MAIN ST
Mailing Address - Street 2:STE 100C
Mailing Address - City:NORTH SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212-1644
Mailing Address - Country:US
Mailing Address - Phone:315-458-2552
Mailing Address - Fax:315-458-2575
Practice Address - Street 1:358 MADISON ST
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:NY
Practice Address - Zip Code:13480-1116
Practice Address - Country:US
Practice Address - Phone:315-841-3222
Practice Address - Fax:315-841-4023
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10857225100000X
NY024302225100000X
PAPT017469225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDD2415Medicare PIN
PA095655UGXMedicare ID - Type Unspecified
NC2509659Medicare PIN