Provider Demographics
NPI:1477187565
Name:WILKIN, MACKENZIE P (PT)
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:P
Last Name:WILKIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MACKENZIE
Other - Middle Name:P
Other - Last Name:YURKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:6850 LOWS ROAD
Mailing Address - Street 2:
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815
Mailing Address - Country:US
Mailing Address - Phone:570-784-7300
Mailing Address - Fax:570-784-7331
Practice Address - Street 1:6850 LOWS ROAD
Practice Address - Street 2:
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815
Practice Address - Country:US
Practice Address - Phone:570-784-7300
Practice Address - Fax:570-784-7331
Is Sole Proprietor?:No
Enumeration Date:2020-02-27
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT028384225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist