Provider Demographics
NPI:1902781776
Name:TAGAL, MA. MIKAELA GARAY II (PT)
Entity type:Individual
Prefix:MS
First Name:MA. MIKAELA
Middle Name:GARAY
Last Name:TAGAL
Suffix:II
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 W BYRON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-2652
Mailing Address - Country:US
Mailing Address - Phone:847-385-1313
Mailing Address - Fax:
Practice Address - Street 1:5400 W BYRON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-2652
Practice Address - Country:US
Practice Address - Phone:847-385-1313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-09
Last Update Date:2025-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053519225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist