Provider Demographics
NPI:1790927622
Name:MCCORMACK, RACHAEL LYNN (MED, LAT, ATC, PES)
Entity Type:Individual
Prefix:MRS
First Name:RACHAEL
Middle Name:LYNN
Last Name:MCCORMACK
Suffix:
Gender:F
Credentials:MED, LAT, ATC, PES
Other - Prefix:MISS
Other - First Name:RACHAEL
Other - Middle Name:LYNN
Other - Last Name:GAMALDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:103 CIRCLE RD
Mailing Address - Street 2:
Mailing Address - City:MILLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17551-1513
Mailing Address - Country:US
Mailing Address - Phone:717-443-5125
Mailing Address - Fax:
Practice Address - Street 1:212 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-2029
Practice Address - Country:US
Practice Address - Phone:717-443-5125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-24
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0040402255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer