Provider Demographics
NPI:1144653296
Name:VIRGILE, MICHAEL TAYLOR (DPT, CSCS, CPT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:TAYLOR
Last Name:VIRGILE
Suffix:
Gender:M
Credentials:DPT, CSCS, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:307 5TH AVE FL 6
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6575
Mailing Address - Country:US
Mailing Address - Phone:212-759-2282
Mailing Address - Fax:212-379-2123
Practice Address - Street 1:235 W 75TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-8220
Practice Address - Country:US
Practice Address - Phone:646-518-5559
Practice Address - Fax:212-400-4247
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0382382251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic