Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 034596 | NY |
NPI | 1003158841 |
---|---|
Provider Name | Dr. Germyn Mckenzie |
First Address | Far Rockaway, NY 11691-2716 |
Second Address | Far Rockaway, NY 11691-2716 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2013 |
Last Update Date | 19/03/2013 |