Provider Demographics
NPI:1114032570
Name:MCKENZIE, KENNETH E (PT)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:E
Last Name:MCKENZIE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5008 W 92ND AVE
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80031-6302
Mailing Address - Country:US
Mailing Address - Phone:318-412-7035
Mailing Address - Fax:318-412-7993
Practice Address - Street 1:5008 W 92ND AVE
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-6302
Practice Address - Country:US
Practice Address - Phone:318-412-7035
Practice Address - Fax:318-412-7993
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA03879R225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1475955Medicaid
LA1475955Medicaid