MEDICARE: MACKENZIE ANN RHEA PT, DPT

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	2014027157	MO
2	225100000X	Physical Therapist	PT4360	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	50654011	OTHER		BCBS-KC

General Provider Information

NPI Number	:	1942612304
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MACKENZIE ANN RHEA PT, DPT

Provider Business Mailing Address
First Line	:	6397 LEE HWY STE 300
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37421-2564
Country	:	US
Telephone Number	:	816-226-4011
Fax Number	:	816-524-6115

Provider Business Practice Location Address
First Line	:	2603 W PLEASANT GROVE RD STE 104
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72758-8514
Country	:	US
Telephone Number	:	479-636-1187
Fax Number	:	479-636-1197

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

Provider Enumeration Date	:	05/20/2014
Last Update Date	:	12/27/2024

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