Provider Demographics
NPI:1528455946
Name:MCCRACKEN, TRAVIS CAMPBELL (PT, DPT)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:CAMPBELL
Last Name:MCCRACKEN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 OXBOW DR
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02633-2035
Mailing Address - Country:US
Mailing Address - Phone:619-606-6357
Mailing Address - Fax:
Practice Address - Street 1:9 WEST RD STE 160
Practice Address - Street 2:
Practice Address - City:ORLEANS
Practice Address - State:MA
Practice Address - Zip Code:02653-3200
Practice Address - Country:US
Practice Address - Phone:508-255-4181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-23
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1255601225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist