MEDICARE: MACKENZIE KENDALL

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

General Provider Information

NPI Number	:	1952055824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MACKENZIE KENDALL

Provider Business Mailing Address
First Line	:	7505 N LOOP 1604 E STE 101
Second Line	:
City	:	LIVE OAK
State	:	TX
Zip	:	78233-2604
Country	:	US
Telephone Number	:	210-590-4000
Fax Number	:

Provider Business Practice Location Address
First Line	:	184 CREEKSIDE PARK RD STE 200
Second Line	:
City	:	SPRING BRANCH
State	:	TX
Zip	:	78070-6240
Country	:	US
Telephone Number	:	830-980-4565
Fax Number	:

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

Provider Enumeration Date	:	02/09/2022
Last Update Date	:	02/09/2022

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Directions to “ MACKENZIE KENDALL ” Practice Location

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