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General NPI Number Information
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NPI Number | 1588875074
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Entity Type | Individual
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Provider Name | CAMILLE MCKENZIE DPT
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Gender | Female
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Dates
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Enumeration Date | 05/25/2007
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Last Update Date | 11/10/2011
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Provider Practice Location Address
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Address Line | 13724 WINDING OAK CIR APT 203
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City | CENTREVILLE
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State | VA
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Zip | 20121-4766
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Country | US
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Telephone | 111-111-1111
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Fax |
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Provider Business Mailing Address
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Address Line | 13724 WINDING OAK CIR APT 203
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City | CENTREVILLE
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State | VA
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Zip | 20121-4766
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | P55105
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 2305206641
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2305206641
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License Number State | VA
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