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NPI Code Detail

MEDICARE: MACKENZIE STREACKER

MEDICARE: MACKENZIE STREACKER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant013342OH

General Provider Information

NPI Number : 1194431338
Entity Type Code : Individual
Provider Name (Legal Business Name) : MACKENZIE STREACKER
Provider Business Mailing Address
First Line : 49 TOMB ST
Second Line :
City : TIFFIN
State : OH
Zip : 44883-1164
Country : US
Telephone Number : 419-618-0465
Fax Number :
Provider Business Practice Location Address
First Line : 1001 PARK AVE
Second Line :
City : FOSTORIA
State : OH
Zip : 44830-1455
Country : US
Telephone Number : 419-435-8163
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2023
Last Update Date : 01/30/2023

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Directions to “ MACKENZIE STREACKER ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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