Provider Demographics
NPI:1164230520
Name:MCCRELESS, DAVID KEITH (ATC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:KEITH
Last Name:MCCRELESS
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 RABBITTOWN RD
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35905-1100
Mailing Address - Country:US
Mailing Address - Phone:256-295-4436
Mailing Address - Fax:
Practice Address - Street 1:1917 BLACK CREEK PKWY
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35904-4584
Practice Address - Country:US
Practice Address - Phone:256-295-4436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7762255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer