Healthcare Provider Details

I. General information

NPI: 1316665276
Provider Name (Legal Business Name): MACKENZIE KATHRYN WOODS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2022
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 S WILCOX ST STE B
CASTLE ROCK CO
80104-1951
US

IV. Provider business mailing address

390 S WILCOX ST STE B
CASTLE ROCK CO
80104-1951
US

V. Phone/Fax

Practice location:
  • Phone: 303-839-8068
  • Fax: 303-835-3597
Mailing address:
  • Phone: 303-839-8068
  • Fax: 303-835-3597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number111683
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP059926T
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: