Provider Demographics
NPI:1922531417
Name:TOOZE, MACKENZIE (LMT)
Entity Type:Individual
Prefix:MISS
First Name:MACKENZIE
Middle Name:
Last Name:TOOZE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8624 BLACKHAWK CT SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97317-6967
Mailing Address - Country:US
Mailing Address - Phone:503-881-6719
Mailing Address - Fax:
Practice Address - Street 1:189 LIBERTY ST NE
Practice Address - Street 2:SUITE 104B
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3682
Practice Address - Country:US
Practice Address - Phone:503-881-6719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-11
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR21522225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist