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General NPI Number Information
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NPI Number | 1548798754
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Entity Type | Individual
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Provider Name | MACKENZIE SUSAN BURNS-KASPER
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Gender | Female
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Dates
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Enumeration Date | 06/01/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 316 W SPRUCE ST
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City | MISSOULA
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State | MT
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Zip | 59802-4108
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Country | US
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Telephone | 406-541-9500
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Fax |
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Provider Business Mailing Address
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Address Line | 820 S 6TH ST W
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City | MISSOULA
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State | MT
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Zip | 59801-3755
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Country | US
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Telephone | 971-222-6601
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PTP-PT-LIC-12956
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License Number State | MT
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