Provider Demographics
NPI:1003330614
Name:HUFFMAN, MCKENZIE S (PT)
Entity Type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:S
Last Name:HUFFMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MCKENZIE
Other - Middle Name:S
Other - Last Name:EMRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1240
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-1240
Mailing Address - Country:US
Mailing Address - Phone:606-325-7955
Mailing Address - Fax:606-325-9848
Practice Address - Street 1:2400 13TH ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41102
Practice Address - Country:US
Practice Address - Phone:606-329-0910
Practice Address - Fax:606-325-8434
Is Sole Proprietor?:No
Enumeration Date:2017-07-26
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY007141225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist