Provider Demographics
NPI:1609826015
Name:MCKENZIE, LAURA KLEIN (PT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:KLEIN
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:ELLEN
Other - Last Name:KLEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11812 MOUNTBATTEN WAY
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-6015
Mailing Address - Country:US
Mailing Address - Phone:336-847-1747
Mailing Address - Fax:
Practice Address - Street 1:11812 MOUNTBATTEN WAY
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-6015
Practice Address - Country:US
Practice Address - Phone:336-847-1747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10164225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7211965Medicaid