Provider Demographics
NPI:1043479728
Name:MCKENZIE, JUDITH D (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:D
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:MRS
Other - First Name:JUDY
Other - Middle Name:
Other - Last Name:MCKENZIE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:8020 S FRANKLIN RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46259-7632
Mailing Address - Country:US
Mailing Address - Phone:317-862-9923
Mailing Address - Fax:317-862-9937
Practice Address - Street 1:8020 S FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46259-7632
Practice Address - Country:US
Practice Address - Phone:317-862-9923
Practice Address - Fax:317-862-9937
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05000535A225100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200643010Medicaid