Provider Demographics
NPI:1417560913
Name:MCCLANAHAN, MCKENZIE ALEXANDRA (DPT)
Entity Type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:ALEXANDRA
Last Name:MCCLANAHAN
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 1:29 NORMANDY CIR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111-6135
Mailing Address - Country:US
Mailing Address - Phone:901-491-2540
Mailing Address - Fax:901-867-1603
Practice Address - Street 1:1751 DANCY BLVD STE 2
Practice Address - Street 2:
Practice Address - City:HORN LAKE
Practice Address - State:MS
Practice Address - Zip Code:38637-1916
Practice Address - Country:US
Practice Address - Phone:901-292-5313
Practice Address - Fax:901-867-1603
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN128982251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty