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General NPI Number Information
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NPI Number | 1780318295
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Entity Type | Individual
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Provider Name | MACKENZIE ERYN BRANNAN PT
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Gender | Female
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Dates
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Enumeration Date | 07/11/2022
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Last Update Date | 08/10/2022
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Provider Practice Location Address
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Address Line | 7580 CLARINGTON CV
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City | SOUTHAVEN
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State | MS
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Zip | 38671-5657
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Country | US
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Telephone | 901-259-1600
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Fax | 901-259-1698
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Provider Business Mailing Address
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Address Line | 6077 PRIMACY PKWY STE 140
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City | MEMPHIS
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State | TN
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Zip | 38119-5754
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Country | US
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Telephone | 901-641-3000
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Fax | 901-259-1698
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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 | 7417
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License Number State | MS
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