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General NPI Number Information
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NPI Number | 1881350585
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Entity Type | Individual
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Provider Name | KERI-ANNE MACKENZIE PTA
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Gender | Female
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Dates
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Enumeration Date | 11/17/2021
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Last Update Date | 11/17/2021
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Provider Practice Location Address
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Address Line | 11 KILLIAN LN
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City | CHARLES TOWN
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State | WV
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Zip | 25414-4889
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Country | US
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Telephone | 774-280-6935
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Fax |
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Provider Business Mailing Address
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Address Line | 2720 CHARLES TOWN RD
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City | MARTINSBURG
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State | WV
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Zip | 25405-5626
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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 | 002347
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License Number State | WV
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