Provider Demographics
NPI:1790848414
Name:MCCRACKEN, THOMAS (PT)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:MCCRACKEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-5732
Mailing Address - Country:US
Mailing Address - Phone:304-232-4002
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL PARK
Practice Address - Street 2:WHEELING HOSPITAL INC
Practice Address - City:WHEELING
Practice Address - State:WA
Practice Address - Zip Code:26003
Practice Address - Country:US
Practice Address - Phone:304-243-3124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1036225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7490OtherOHIO LICENSE
PAPT7511LOtherPENNSYLVANIA LICENSE