Healthcare Provider Details

I. General information

NPI: 1902791213
Provider Name (Legal Business Name): MACKENZIE RYAN TAYLOR PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2025
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5983 RICHMOND TAPPAHANNOCK HWY
AYLETT VA
23009-3009
US

IV. Provider business mailing address

7330 ELKO RD
SANDSTON VA
23150-5803
US

V. Phone/Fax

Practice location:
  • Phone: 804-769-7504
  • Fax: 804-769-7524
Mailing address:
  • Phone: 804-690-8673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305217175
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: