Provider Demographics
NPI:1548461312
Name:LEOGRANDE, MICHAEL T JR (MSPT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:T
Last Name:LEOGRANDE
Suffix:JR
Gender:M
Credentials:MSPT
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Mailing Address - Street 1:85 NASSAU ST
Mailing Address - Street 2:
Mailing Address - City:ISLIP TERRACE
Mailing Address - State:NY
Mailing Address - Zip Code:11752-2811
Mailing Address - Country:US
Mailing Address - Phone:516-996-1179
Mailing Address - Fax:631-754-3816
Practice Address - Street 1:694 FORT SALONGA RD
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-3147
Practice Address - Country:US
Practice Address - Phone:631-734-3775
Practice Address - Fax:631-754-3816
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2021-04-02
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Provider Licenses
StateLicense IDTaxonomies
NY018666225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQOW011Medicare PIN
NYQ51201Medicare PIN