Provider Demographics
NPI:1255869707
Name:MACKENZIE BROWN LLC
Entity Type:Organization
Organization Name:MACKENZIE BROWN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MACKENZIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:808-757-5724
Mailing Address - Street 1:PO BOX 811
Mailing Address - Street 2:
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768-0811
Mailing Address - Country:US
Mailing Address - Phone:808-757-5724
Mailing Address - Fax:808-442-1421
Practice Address - Street 1:810 KOKOMO RD STE 159
Practice Address - Street 2:
Practice Address - City:HAIKU
Practice Address - State:HI
Practice Address - Zip Code:96708-5081
Practice Address - Country:US
Practice Address - Phone:804-822-2262
Practice Address - Fax:808-442-1421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-29
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2251S0007X
2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Single Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty