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General NPI Number Information
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NPI Number | 1568305597
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Entity Type | Individual
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Provider Name | MARK MACKENZIE CADIZ PT
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Gender | Male
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Dates
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Enumeration Date | 04/13/2026
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Last Update Date | 04/13/2026
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Provider Practice Location Address
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Address Line | 2200 WAUKEGAN RD
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City | GLENVIEW
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State | IL
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Zip | 60025-1759
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Country | US
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Telephone | 312-878-8800
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Fax |
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Provider Business Mailing Address
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Address Line | 12501 DAVANA DR
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City | SAINT LOUIS
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State | MO
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Zip | 63128-2116
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Country | US
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Telephone | 314-898-3553
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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 | 070.028849
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License Number State | IL
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