Healthcare Provider Details

I. General information

NPI: 1255869707
Provider Name (Legal Business Name): MACKENZIE BROWN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2017
Last Update Date: 04/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 KOKOMO RD STE 159
HAIKU HI
96708-5081
US

IV. Provider business mailing address

PO BOX 811
MAKAWAO HI
96768-0811
US

V. Phone/Fax

Practice location:
  • Phone: 804-822-2262
  • Fax: 808-442-1421
Mailing address:
  • Phone: 808-757-5724
  • Fax: 808-442-1421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number StateHI

VIII. Authorized Official

Name: DR. MACKENZIE A BROWN
Title or Position: OWNER, PHYSICAL THERAPIST
Credential: DPT
Phone: 808-757-5724