Individual
MARYKATE GLACKIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
570 SOUTH AVE E STE C, CRANFORD, NJ 07016-3200
(908) 325-6556
Mailing address
56 LEFFERTS LN, CLARK, NJ 07066-2331
(732) 770-9628
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
40QB00365200
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
40QB00365200
NEW JERSEY STATE BOARD OF PHYSICAL THERAPY
NJ
Enumeration date
01/12/2022
Last updated
01/12/2022
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