Provider Demographics
NPI:1811385768
Name:MCKENZIE, TONYA (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 MONROE AVE
Mailing Address - Street 2:APT 306
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15202
Mailing Address - Country:US
Mailing Address - Phone:484-855-0409
Mailing Address - Fax:
Practice Address - Street 1:527 MONROE AVE
Practice Address - Street 2:APT 306
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15202
Practice Address - Country:US
Practice Address - Phone:484-855-0409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-30
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARTO0001792255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer