MEDICARE: CHRISTY MACKIEWICZ P.T.

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	7757	WA

General Provider Information

NPI Number	:	1811979651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTY MACKIEWICZ P.T.

Provider Business Mailing Address
First Line	:	2312 W MAIN ST
Second Line	:	117
City	:	BATTLE GROUND
State	:	WA
Zip	:	98604-4234
Country	:	US
Telephone Number	:	360-687-7147
Fax Number	:

Provider Business Practice Location Address
First Line	:	2312 W MAIN ST
Second Line	:	117
City	:	BATTLE GROUND
State	:	WA
Zip	:	98604-4234
Country	:	US
Telephone Number	:	360-687-7147
Fax Number	:

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

Provider Enumeration Date	:	11/17/2005
Last Update Date	:	07/08/2007

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