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General NPI Number Information
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NPI Number | 1386492056
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Entity Type | Individual
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Provider Name | MCKENZIE PULSIPHER DPT
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Gender | Female
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Dates
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Enumeration Date | 05/08/2024
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Last Update Date | 04/10/2025
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Provider Practice Location Address
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Address Line | 2175 N WHITLEY DR
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City | FRUITLAND
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State | ID
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Zip | 83619-2132
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Country | US
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Telephone | 208-452-7197
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Fax |
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Provider Business Mailing Address
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Address Line | 5828 W STRIKER LN
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City | EAGLE
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State | ID
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Zip | 83616-5733
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Country | US
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Telephone |
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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 | PT-9159
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License Number State | ID
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