Healthcare Provider Details

I. General information

NPI: 1811162860
Provider Name (Legal Business Name): HENRY MCCRACKING DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 04/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

US NAVAL HOSPITAL ROTA SPAIN PSC 819 BOX 18
FPO AE
09645
US

IV. Provider business mailing address

US NAVAL HOSPITAL ROTA SPAIN PSC 819 BOX 18
FPO AE
09645
US

V. Phone/Fax

Practice location:
  • Phone: 01134956823524
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number9437
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: