MEDICARE: MACKENZIE POPP

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
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1396442109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MACKENZIE POPP

Provider Business Mailing Address
First Line	:	27935 NE 26TH ST
Second Line	:
City	:	REDMOND
State	:	WA
Zip	:	98053-3116
Country	:	US
Telephone Number	:	425-691-6563
Fax Number	:

Provider Business Practice Location Address
First Line	:	1303 W SUMMIT PKWY LOWR LEVEL1
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99201-7033
Country	:	US
Telephone Number	:	509-579-4300
Fax Number	:	509-317-9542

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2023
Last Update Date	:	02/13/2023

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Directions to “ MACKENZIE POPP ” Practice Location

Language	Start Address	Practice Location

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