Provider Demographics
NPI:1437761889
Name:MACKENZIE, MORGAN (DPT)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:
Last Name:MACKENZIE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MORGAN
Other - Middle Name:
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5053 COUNTRY CLUB DR STE 220
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:ID
Mailing Address - Zip Code:83455-5164
Mailing Address - Country:US
Mailing Address - Phone:208-254-1777
Mailing Address - Fax:
Practice Address - Street 1:18 N MAIN ST STE 220
Practice Address - Street 2:
Practice Address - City:DRIGGS
Practice Address - State:ID
Practice Address - Zip Code:83422-5141
Practice Address - Country:US
Practice Address - Phone:208-254-1777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2025-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID7026225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist