Provider Demographics
NPI:1518189695
Name:MCKENZIE, DEBORAH ANN (PT)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANN
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7968 WOODBURY ROAD
Mailing Address - Street 2:
Mailing Address - City:LAINGSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:48848
Mailing Address - Country:US
Mailing Address - Phone:517-651-7752
Mailing Address - Fax:
Practice Address - Street 1:3394 E JOLLY ROAD
Practice Address - Street 2:INGHAM REGIONAL MEDICAL CENTER REBOUND REHAB
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910
Practice Address - Country:US
Practice Address - Phone:517-372-6291
Practice Address - Fax:517-346-4844
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5501002828225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist