Provider Demographics
NPI:1114757770
Name:FRACKLETON, MICHEALINA (LMT, CLT, PTA, CES)
Entity type:Individual
Prefix:MS
First Name:MICHEALINA
Middle Name:
Last Name:FRACKLETON
Suffix:
Gender:F
Credentials:LMT, CLT, PTA, CES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 BALDPATE RD
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:MA
Mailing Address - Zip Code:01833-2302
Mailing Address - Country:US
Mailing Address - Phone:781-405-1986
Mailing Address - Fax:
Practice Address - Street 1:100 MAIN ST STE 12
Practice Address - Street 2:
Practice Address - City:AMESBURY
Practice Address - State:MA
Practice Address - Zip Code:01913-2822
Practice Address - Country:US
Practice Address - Phone:781-405-1986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1959225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist