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NPI Code Detail

MEDICARE: MCKENZIE KETCHER

MEDICARE: MCKENZIE KETCHER
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
1225100000XPhysical Therapist12976544-2401UT

General Provider Information

NPI Number : 1457070492
Entity Type Code : Individual
Provider Name (Legal Business Name) : MCKENZIE KETCHER
Provider Business Mailing Address
First Line : 390 CAMPBELL LN NW
Second Line :
City : HUTCHINSON
State : MN
Zip : 55350-1449
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1212 E WILMINGTON AVE
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84106-2851
Country : US
Telephone Number : 801-486-6000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/23/2022
Last Update Date : 08/23/2022

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Directions to “ MCKENZIE KETCHER ” Practice Location

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