Provider Demographics
NPI:1801381298
Name:JANNER, MACKENZIE (PT)
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:
Last Name:JANNER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9506 NALL AVE
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66207-2950
Mailing Address - Country:US
Mailing Address - Phone:913-912-1096
Mailing Address - Fax:913-912-1157
Practice Address - Street 1:9506 NALL AVE
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66207-2950
Practice Address - Country:US
Practice Address - Phone:913-912-1096
Practice Address - Fax:913-912-1157
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-05940225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist