Provider Demographics
NPI:1356657217
Name:MCKENZIE, CHRISTIE (PT)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CHRISTIE
Other - Middle Name:
Other - Last Name:PELTZMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18 GOLDENROD TRL
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-1548
Mailing Address - Country:US
Mailing Address - Phone:917-650-2806
Mailing Address - Fax:
Practice Address - Street 1:18 GOLDENROD TRL
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-1548
Practice Address - Country:US
Practice Address - Phone:917-650-2806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-29
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008769225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist