Provider Demographics
NPI:1538132535
Name:MCKENZIE, RENEE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:RENEE
Other - Middle Name:A
Other - Last Name:COUGHENOUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:240 RED TAIL STE 3&4
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1581
Mailing Address - Country:US
Mailing Address - Phone:716-674-9600
Mailing Address - Fax:
Practice Address - Street 1:240 REDTAIL DRIVE
Practice Address - Street 2:SUITES 3 & 4
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127
Practice Address - Country:US
Practice Address - Phone:716-674-9600
Practice Address - Fax:716-674-9700
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027606225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA8916Medicare ID - Type Unspecified