Provider Demographics
NPI:1447670344
Name:MCCABE, PETER CLINTON (MS, ATC, PES)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:CLINTON
Last Name:MCCABE
Suffix:
Gender:M
Credentials:MS, ATC, PES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4245 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-3703
Mailing Address - Country:US
Mailing Address - Phone:585-389-2838
Mailing Address - Fax:
Practice Address - Street 1:4245 EAST AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-3703
Practice Address - Country:US
Practice Address - Phone:585-389-2838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-18
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0017622255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer