Provider Demographics
NPI:1841755071
Name:SAMESHIMA, MCKENZIE DAVIS (DPT)
Entity Type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:DAVIS
Last Name:SAMESHIMA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MCKENZIE
Other - Middle Name:DAVIS
Other - Last Name:SAMESHIMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:PO BOX 2650
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-8650
Mailing Address - Country:US
Mailing Address - Phone:972-724-2400
Mailing Address - Fax:972-724-2495
Practice Address - Street 1:12500 DALLAS PKWY
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-4229
Practice Address - Country:US
Practice Address - Phone:469-604-9000
Practice Address - Fax:469-604-9001
Is Sole Proprietor?:No
Enumeration Date:2019-02-01
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1314597208100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist