Provider Demographics
NPI:1700178043
Name:MCCREE, VICKI LYNNE (RPT)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:LYNNE
Last Name:MCCREE
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3709 CHERRYWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90018-4010
Mailing Address - Country:US
Mailing Address - Phone:323-294-9723
Mailing Address - Fax:323-294-9723
Practice Address - Street 1:3709 CHERRYWOOD AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90018-4010
Practice Address - Country:US
Practice Address - Phone:323-294-9723
Practice Address - Fax:323-294-9723
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23225225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist