Provider Demographics
NPI:1407089071
Name:SHECKFEE, MACKIE D (DPT)
Entity Type:Individual
Prefix:
First Name:MACKIE
Middle Name:D
Last Name:SHECKFEE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 HAWTHORNE AVE
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:CT
Mailing Address - Zip Code:06418-1142
Mailing Address - Country:US
Mailing Address - Phone:203-213-0610
Mailing Address - Fax:
Practice Address - Street 1:102 HAWTHORNE AVE
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:CT
Practice Address - Zip Code:06418-1142
Practice Address - Country:US
Practice Address - Phone:203-231-0610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-31
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008604225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist