Healthcare Provider Details

I. General information

NPI: 1508426321
Provider Name (Legal Business Name): CHRISTOPHER MACKAY DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2019
Last Update Date: 06/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6649 UNIVERSITY AVE STE 100
MIDDLETON WI
53562-3021
US

IV. Provider business mailing address

4200 UNIVERSITY AVE APT 304
MADISON WI
53705-2130
US

V. Phone/Fax

Practice location:
  • Phone: 608-841-1290
  • Fax: 608-841-1299
Mailing address:
  • Phone: 208-995-1938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number14611-24
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: