Provider Demographics
NPI:1760706865
Name:MCCREARY, DAWN G (LMT)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:G
Last Name:MCCREARY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5943 CALAIS BLVD N
Mailing Address - Street 2:UNIT 4
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33714-4769
Mailing Address - Country:US
Mailing Address - Phone:727-403-9307
Mailing Address - Fax:
Practice Address - Street 1:3330 DR MARTIN LUTHER KING JR ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33704-1212
Practice Address - Country:US
Practice Address - Phone:727-403-9307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-17
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA47324225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist