Healthcare Provider Details

I. General information

NPI: 1194445866
Provider Name (Legal Business Name): MACKENZIE ROBBINS PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2022
Last Update Date: 09/01/2022
Certification Date: 08/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 DWIGHT AVE
CLINTON NY
13323-1600
US

IV. Provider business mailing address

8294 E FLOYD RD
ROME NY
13440-0646
US

V. Phone/Fax

Practice location:
  • Phone: 315-723-2886
  • Fax:
Mailing address:
  • Phone: 315-225-6134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number049231-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: