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General NPI Number Information
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NPI Number | 1629960968
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Entity Type | Individual
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Provider Name | MACKENZIE BAEHR PTA
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Gender |
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Dates
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Enumeration Date | 07/21/2025
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Last Update Date | 07/21/2025
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Provider Practice Location Address
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Address Line | 5025 SMITHFIELD
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City | MELBOURNE
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State | FL
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Zip | 32934-2808
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Country | US
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Telephone | 321-947-6417
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Fax |
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Provider Business Mailing Address
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Address Line | 1435 DIABLO CIR SW
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City | PALM BAY
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State | FL
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Zip | 32908-6443
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA34171
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License Number State | FL
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