Healthcare Provider Details

I. General information

NPI: 1588590624
Provider Name (Legal Business Name): MACKENZIE DANIELLE KRAUSE PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2916 S 4TH ST STE 200
LEAVENWORTH KS
66048-5016
US

IV. Provider business mailing address

2916 S 4TH ST STE 200
LEAVENWORTH KS
66048-5016
US

V. Phone/Fax

Practice location:
  • Phone: 913-225-9340
  • Fax: 913-273-8484
Mailing address:
  • Phone: 913-225-9340
  • Fax: 913-273-8484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number14-04331
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: