MEDICARE: MACKENZIE KUMPF

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	225200000X	Physical Therapy Assistant	PTA.0014825	CO

General Provider Information

NPI Number	:	1952983983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MACKENZIE KUMPF

Provider Business Mailing Address
First Line	:	7329 S PLATTE RIVER PKWY UNIT 207
Second Line	:
City	:	LITTLETON
State	:	CO
Zip	:	80120-4301
Country	:	US
Telephone Number	:	610-496-9449
Fax Number	:

Provider Business Practice Location Address
First Line	:	1535 PARK AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80218-1657
Country	:	US
Telephone Number	:	844-334-3818
Fax Number	:

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

Provider Enumeration Date	:	04/28/2021
Last Update Date	:	04/28/2021

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Directions to “ MACKENZIE KUMPF ” Practice Location

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