Provider Demographics
NPI:1114094570
Name:MCKENZIE, BRENDA S (PT)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:S
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:S
Other - Last Name:KEPLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 24366
Mailing Address - Street 2:MS 359107
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-0366
Mailing Address - Country:US
Mailing Address - Phone:206-598-0502
Mailing Address - Fax:206-598-0516
Practice Address - Street 1:4245 ROOSEVELT WAY NE
Practice Address - Street 2:BOX 354745
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-6008
Practice Address - Country:US
Practice Address - Phone:206-598-2888
Practice Address - Fax:206-598-4484
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008683225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist