1790927622 NPI number — MRS. RACHAEL LYNN MCCORMACK M.ED., LAT, ATC, PES

Table of content: MRS. RACHAEL LYNN MCCORMACK M.ED., LAT, ATC, PES (NPI 1790927622)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790927622 NPI number — MRS. RACHAEL LYNN MCCORMACK M.ED., LAT, ATC, PES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCORMACK
Provider First Name:
RACHAEL
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.ED., LAT, ATC, PES
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GAMALDI
Provider Other First Name:
RACHAEL
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1790927622
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/17/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
103 CIRCLE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILLERSVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17551-1513
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-443-5125
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
212 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LITITZ
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17543-2029
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-443-5125
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/24/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2255A2300X , with the licence number:  RT004040 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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