Healthcare Provider Details

I. General information

NPI: 1598278715
Provider Name (Legal Business Name): JOSIE L MCCRACKEN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2017
Last Update Date: 12/15/2021
Certification Date: 12/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 E QUINCY ST
LEWISTOWN MO
63452-2560
US

IV. Provider business mailing address

1025 MAINE ST
QUINCY IL
62301-4038
US

V. Phone/Fax

Practice location:
  • Phone: 573-215-2715
  • Fax: 573-497-2322
Mailing address:
  • Phone: 217-222-6550
  • Fax: 217-277-2253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2017026961
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: