Healthcare Provider Details

I. General information

NPI: 1790617835
Provider Name (Legal Business Name): MACKENZIE WOO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 LAWRENCE EXPY DEPT 174
SANTA CLARA CA
95051-5173
US

IV. Provider business mailing address

3919 SOUTIRAGE LN
SAN JOSE CA
95135-1734
US

V. Phone/Fax

Practice location:
  • Phone: 408-851-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number310133
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: