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Individual
JOAN M MACK
Active
Individual
JOAN M MACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
0029001
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0184495
—
NY
01
—
AA0727
MEDICARE GROUP NUMBER
—
Enumeration date
10/26/2005
Last updated
09/13/2010
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