MEDICARE: MACKENZIE LEIGH SKOUMAL

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	PT04044	RI

General Provider Information

NPI Number	:	1184418659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MACKENZIE LEIGH SKOUMAL

Provider Business Mailing Address
First Line	:	1726 S COLUMBIAN RD
Second Line	:
City	:	OREGON
State	:	IL
Zip	:	61061-9211
Country	:	US
Telephone Number	:	815-217-5466
Fax Number	:

Provider Business Practice Location Address
First Line	:	7878 WADSWORTH BLVD STE 210
Second Line	:
City	:	ARVADA
State	:	CO
Zip	:	80003-2121
Country	:	US
Telephone Number	:	303-456-8967
Fax Number	:

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

Provider Enumeration Date	:	04/08/2025
Last Update Date	:	12/08/2025

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