Healthcare Provider Details

I. General information

NPI: 1366882672
Provider Name (Legal Business Name): MCKENZI R JOZIC D.P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MCKENZI R VANFOSSEN D.P.T.

II. Dates (important events)

Enumeration Date: 07/01/2013
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2607 WYOMING BLVD NE
ALBUQUERQUE NM
87112-1029
US

IV. Provider business mailing address

PO BOX 33396
N ROYALTON OH
44133-0396
US

V. Phone/Fax

Practice location:
  • Phone: 505-296-9521
  • Fax:
Mailing address:
  • Phone: 440-230-1133
  • Fax: 440-230-9243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT014260
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5149
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: