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General NPI Number Information
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NPI Number | 1124755327
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Entity Type | Individual
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Provider Name | MACKENZIE AINE JOHNSON DPT
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Gender | Female
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Dates
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Enumeration Date | 08/07/2022
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Last Update Date | 08/07/2022
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Provider Practice Location Address
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Address Line | 1111 E OLIVE ST UNIT 516
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City | SEATTLE
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State | WA
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Zip | 98122-7052
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Country | US
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Telephone | 971-285-6011
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Fax |
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Provider Business Mailing Address
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Address Line | 2821 NW MARKET ST STE E
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City | SEATTLE
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State | WA
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Zip | 98107-5815
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Country | US
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Telephone | 206-706-0063
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 61263726
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License Number State | WA
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