Individual
MR. MICHAEL JASON MAGGARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
897 BROADWAY, NEW YORK, NY 10003-1205
(212) 674-7878
(212) 673-7878
Mailing address
198 AVENUE A APT 3B, NEW YORK, NY 10009-3401
(917) 674-3950
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
006306-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
006306-1
LICENSE NUMBER
NY
Enumeration date
08/09/2006
Last updated
07/08/2007
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