Provider Demographics
NPI:1720567365
Name:NIX, MACKENZIE ZAIRE (DPT)
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:ZAIRE
Last Name:NIX
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KENZIE
Other - Middle Name:
Other - Last Name:NIX
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7040 25TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-5848
Mailing Address - Country:US
Mailing Address - Phone:136-079-0036
Mailing Address - Fax:
Practice Address - Street 1:325 9TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2499
Practice Address - Country:US
Practice Address - Phone:206-744-2506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60843244225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist