Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | PT018791 | PA |
Y | 2251S0007X | Physical Therapist - Sports | PT018791 | PA |
N | 2251X0800X | Physical Therapist - Orthopedic | PT018791 | PA |
NPI | 1255589016 |
---|---|
Provider Name | Christopher Michael Mckenzie |
First Address | Philadelphia, PA 19129-1636 |
Second Address | Philadelphia, PA 19129-1636 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2008 |
Last Update Date | 08/03/2017 |