Provider Demographics
NPI:1548735319
Name:KUHN, MCKENZIE JERRIT (PT, DPT, ATC)
Entity Type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:JERRIT
Last Name:KUHN
Suffix:
Gender:F
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5138 41ST AVE
Mailing Address - Street 2:
Mailing Address - City:NEW SALEM
Mailing Address - State:ND
Mailing Address - Zip Code:58563-9769
Mailing Address - Country:US
Mailing Address - Phone:701-595-1555
Mailing Address - Fax:
Practice Address - Street 1:3921 LOCKPORT ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-5541
Practice Address - Country:US
Practice Address - Phone:701-751-3128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-09
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2255A2300X
ND2455225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty