Provider Demographics
NPI:1386070357
Name:MCCRACKEN, ANGELA MARIE (LPTA)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:MARIE
Last Name:MCCRACKEN
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:MS
Other - First Name:ANGELA
Other - Middle Name:MARIE
Other - Last Name:LESTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1517 RIDGE RD N
Mailing Address - Street 2:
Mailing Address - City:HEDGESVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25427-7289
Mailing Address - Country:US
Mailing Address - Phone:304-839-4076
Mailing Address - Fax:
Practice Address - Street 1:380 MILLWOOD AVE
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-4453
Practice Address - Country:US
Practice Address - Phone:540-667-7010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-22
Last Update Date:2013-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306603421225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant