Provider Demographics
NPI:1891816104
Name:MACKIE, BRIAN KEVIN (PT)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:KEVIN
Last Name:MACKIE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4336 FALLBROOK BLVD
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-2650
Mailing Address - Country:US
Mailing Address - Phone:727-433-4906
Mailing Address - Fax:727-939-9563
Practice Address - Street 1:4336 FALLBROOK BLVD
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34685-2650
Practice Address - Country:US
Practice Address - Phone:727-433-4906
Practice Address - Fax:727-939-9563
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT3335225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist