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General NPI Number Information
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NPI Number | 1326919002
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Entity Type | Individual
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Provider Name | MAKENZIE DIANA SOVERCOOL
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Gender | Female
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Dates
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Enumeration Date | 09/15/2025
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Last Update Date | 09/15/2025
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Provider Practice Location Address
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Address Line | 13780 SE 100TH AVE
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City | BELLEVIEW
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State | FL
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Zip | 34420-6955
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Country | US
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Telephone | 352-789-0713
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Fax |
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Provider Business Mailing Address
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Address Line | 324 N YORK ST
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City | BUSHNELL
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State | FL
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Zip | 33513-5304
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Country | US
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Telephone | 352-801-4287
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 33587
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License Number State | FL
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