Provider Demographics
NPI:1407630429
Name:CHRISTENSEN, MACENZIE MORGAN (DPT)
Entity Type:Individual
Prefix:
First Name:MACENZIE
Middle Name:MORGAN
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11622 S 191ST AVE
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:NE
Mailing Address - Zip Code:68028-3588
Mailing Address - Country:US
Mailing Address - Phone:402-238-7035
Mailing Address - Fax:
Practice Address - Street 1:6798 N 67TH PLZ
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68152-2115
Practice Address - Country:US
Practice Address - Phone:402-682-8929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4562225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist