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General NPI Number Information
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NPI Number | 1932567609
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Entity Type | Individual
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Provider Name | MACKENZIE WALLEY NASON PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 02/09/2016
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Last Update Date | 04/15/2019
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Provider Practice Location Address
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Address Line | 101 THOMAS LN APT C2
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City | CARRBORO
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State | NC
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Zip | 27510-1362
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Country | US
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Telephone | 919-590-0857
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Fax | 919-883-5471
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Provider Business Mailing Address
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Address Line | 1044 PHILPOTT DR
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City | CHAPEL HILL
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State | NC
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Zip | 27517-7459
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Country | US
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Telephone | 704-942-5828
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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 | 16132
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License Number State | NC
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