Healthcare Provider Details

I. General information

NPI: 1124772249
Provider Name (Legal Business Name): MACKENZIE ROSE CARTER DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MACKENZIE ROSE EBLE DPT

II. Dates (important events)

Enumeration Date: 02/08/2022
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

859 HEALTH PARK BLVD
GRAND BLANC MI
48439-7383
US

IV. Provider business mailing address

3181 SANDHILL RD
MASON MI
48854-9425
US

V. Phone/Fax

Practice location:
  • Phone: 517-336-6060
  • Fax: 517-336-6050
Mailing address:
  • Phone: 517-336-6060
  • Fax: 517-336-6050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501301739
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: