Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 0013734 | FL |
N | 2251X0800X | Physical Therapist - Orthopedic | 0013734 | FL |
NPI | 1790856961 |
---|---|
Provider Name | Dawn M Mackenzie |
First Address | Miami Springs, FL 33166-7226 |
Second Address | Miami Springs, FL 33166-7226 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2006 |
Last Update Date | 15/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Y911 | BCBS (01) | FL |