Provider Demographics
NPI:1689198921
Name:PARKHILL, MACKENZIE WILSON (DPT)
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:WILSON
Last Name:PARKHILL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 VALLEY CENTRE DR
Mailing Address - Street 2:
Mailing Address - City:DRIGGS
Mailing Address - State:ID
Mailing Address - Zip Code:83422-5095
Mailing Address - Country:US
Mailing Address - Phone:208-354-0089
Mailing Address - Fax:509-561-0536
Practice Address - Street 1:600 VALLEY CENTRE DR
Practice Address - Street 2:
Practice Address - City:DRIGGS
Practice Address - State:ID
Practice Address - Zip Code:83422-5095
Practice Address - Country:US
Practice Address - Phone:208-354-0089
Practice Address - Fax:509-561-0536
Is Sole Proprietor?:No
Enumeration Date:2017-07-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID5288225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist