Provider Demographics
NPI:1912777392
Name:MCCRACKEN, KIERSTEN LIZBETH (DPT)
Entity Type:Individual
Prefix:
First Name:KIERSTEN
Middle Name:LIZBETH
Last Name:MCCRACKEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KIERSTEN
Other - Middle Name:LIZBETH
Other - Last Name:COVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2757 LEECHBURG RD
Mailing Address - Street 2:
Mailing Address - City:LOWER BURRELL
Mailing Address - State:PA
Mailing Address - Zip Code:15068-3138
Mailing Address - Country:US
Mailing Address - Phone:724-337-6522
Mailing Address - Fax:724-337-0630
Practice Address - Street 1:3160 KIPP AVE
Practice Address - Street 2:
Practice Address - City:LOWER BURRELL
Practice Address - State:PA
Practice Address - Zip Code:15068-3546
Practice Address - Country:US
Practice Address - Phone:724-335-5526
Practice Address - Fax:724-335-6407
Is Sole Proprietor?:No
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT028646225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist