Healthcare Provider Details

I. General information

NPI: 1285955252
Provider Name (Legal Business Name): DONNA M MCCRACKEN LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2010
Last Update Date: 06/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 CAPITAL ST
GREENWOOD SC
29649-9105
US

IV. Provider business mailing address

137 CAPITAL ST
GREENWOOD SC
29649-9105
US

V. Phone/Fax

Practice location:
  • Phone: 864-229-6200
  • Fax:
Mailing address:
  • Phone: 864-229-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number2611
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: