Provider Demographics
NPI:1639296015
Name:SCHRACK, KEVIN P (PT, OCS, CMTPT)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:P
Last Name:SCHRACK
Suffix:
Gender:M
Credentials:PT, OCS, CMTPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 69030
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-9030
Mailing Address - Country:US
Mailing Address - Phone:757-873-2302
Mailing Address - Fax:757-873-2306
Practice Address - Street 1:1580 ARMORY DR STE B
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:VA
Practice Address - Zip Code:23851-2470
Practice Address - Country:US
Practice Address - Phone:757-562-0990
Practice Address - Fax:757-562-0496
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305001987225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4979699Medicaid
VA1639296015Medicaid
VAQ37411AMedicare PIN
VA1639296015Medicaid
VA1639296015Medicaid