Individual
MR. MICHAEL ANTONIO FORMALE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
13A DICKINSON AVE, NYACK, NY 10960-2914
(845) 353-7000
Mailing address
70 INWOOD ROAD, SCOTCHTOWN, NY 10941
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
013236
NY
Other
Enumeration date
12/04/2023
Last updated
12/04/2023
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