Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 05000535A | IN |
N | 2251P0200X | Physical Therapist - Pediatrics | 05000535A | IN |
NPI | 1043479728 |
---|---|
Provider Name | Mrs. Judith D. Mckenzie |
First Address | Indianapolis, IN 46259-7632 |
Second Address | Indianapolis, IN 46259-7632 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2008 |
Last Update Date | 06/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200643010 | (05) | IN |