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General NPI Number Information
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NPI Number | 1457356404
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Entity Type | Individual
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Provider Name | WILLIAM R MACKENZIE PT
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Gender | Male
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Dates
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Enumeration Date | 06/16/2005
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Last Update Date | 03/06/2009
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Provider Practice Location Address
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Address Line | 11802 NE 65TH ST 100
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City | VANCOUVER
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State | WA
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Zip | 98662-5521
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Country | US
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Telephone | 360-253-6883
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Fax | 360-892-7040
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Provider Business Mailing Address
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Address Line | 11802 NE 65TH ST 100
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City | VANCOUVER
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State | WA
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Zip | 98662-5521
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Country | US
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Telephone | 360-253-6883
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Fax | 360-892-7040
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT00006628
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH00034484
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License Number State | WA
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