Provider Demographics
NPI:1972810042
Name:MCCRACKEN, KINLEY MAY (DPT)
Entity type:Individual
Prefix:
First Name:KINLEY
Middle Name:MAY
Last Name:MCCRACKEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3283 BERNAL AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-6237
Mailing Address - Country:US
Mailing Address - Phone:925-846-1848
Mailing Address - Fax:925-846-1851
Practice Address - Street 1:3283 BERNAL AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-6237
Practice Address - Country:US
Practice Address - Phone:925-846-1848
Practice Address - Fax:925-846-1851
Is Sole Proprietor?:No
Enumeration Date:2010-09-09
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT37079225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADU462ZMedicare PIN