Provider Demographics
NPI:1922260603
Name:RACKEY, DONALD MARK (ATC)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:MARK
Last Name:RACKEY
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1442 N CLIFFSIDE DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2659
Mailing Address - Country:US
Mailing Address - Phone:480-892-2121
Mailing Address - Fax:
Practice Address - Street 1:2451 E BASELINE RD
Practice Address - Street 2:# 220
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2471
Practice Address - Country:US
Practice Address - Phone:480-892-2121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
AZ05022255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer