MEDICARE: KENNETH E MCKENZIE PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	03879R	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114032570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH E MCKENZIE PT

Provider Business Mailing Address
First Line	:	5008 W 92ND AVE
Second Line	:
City	:	WESTMINSTER
State	:	CO
Zip	:	80031-6302
Country	:	US
Telephone Number	:	318-412-7035
Fax Number	:	318-412-7993

Provider Business Practice Location Address
First Line	:	5008 W 92ND AVE
Second Line	:
City	:	WESTMINSTER
State	:	CO
Zip	:	80031-6302
Country	:	US
Telephone Number	:	318-412-7035
Fax Number	:	318-412-7993

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	11/08/2021

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