Provider Demographics
NPI:1790856961
Name:MACKENZIE, DAWN M (PT)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:M
Last Name:MACKENZIE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4491 NW 36TH ST
Mailing Address - Street 2:SUITE H
Mailing Address - City:MIAMI SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-7226
Mailing Address - Country:US
Mailing Address - Phone:305-492-9933
Mailing Address - Fax:305-492-9944
Practice Address - Street 1:4491 NW 36TH ST
Practice Address - Street 2:SUITE H
Practice Address - City:MIAMI SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33166-7226
Practice Address - Country:US
Practice Address - Phone:305-492-9933
Practice Address - Fax:305-492-9944
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL00137342251N0400X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY911OtherBCBS