Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 60160978 | WA |
NPI | 1124621271 |
---|---|
Provider Name | Karena Mckenzie |
First Address | Bremerton, WA 98310-4423 |
Second Address | Tacoma, WA 98405-4265 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2020 |
Last Update Date | 14/04/2021 |