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General NPI Number Information
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NPI Number | 1376967083
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Entity Type | Organization
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Legal Business Name | MCKENZIE SPORTS THERAPY LLC
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Dates
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Enumeration Date | 02/17/2014
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Last Update Date | 10/18/2022
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Provider Practice Location Address
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Address Line | 161 LEVERINGTON AVE STE 1004
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City | PHILADELPHIA
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State | PA
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Zip | 19127-2076
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Country | US
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Telephone | 267-332-8102
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Fax | 877-313-1445
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Provider Business Mailing Address
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Address Line | 161 LEVERINGTON AVE STE 1004
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City | PHILADELPHIA
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State | PA
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Zip | 19127-2076
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Country | US
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Telephone | 267-332-8102
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Fax | 877-313-1445
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | CHRISTOPHER MICHAEL MCKENZIE
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Credential | PT, DPT
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Telephone | 267-332-8102
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251S0007X
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Taxonomy Name | Sports Physical Therapist
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License Number | PT018791
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License Number State | PA
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