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General NPI Number Information
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NPI Number | 1699530667
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Entity Type | Individual
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Provider Name | DR. MACKENZIE LALLY
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Gender | Female
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Dates
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Enumeration Date | 02/19/2024
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Last Update Date | 02/19/2024
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Provider Practice Location Address
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Address Line | 1349 E 79TH ST
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City | CLEVELAND
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State | OH
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Zip | 44103-2864
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Country | US
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Telephone | 216-838-2976
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Fax |
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Provider Business Mailing Address
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Address Line | 8725 SUMMER WIND LN
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City | MENTOR
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State | OH
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Zip | 44060-1585
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Country | US
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Telephone | 203-535-9382
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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 | PT020892
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License Number State | OH
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