Provider Demographics
NPI:1013681535
Name:SWANK, MACKENZIE LORRAINE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:LORRAINE
Last Name:SWANK
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8219 BUCHANAN TRL W
Mailing Address - Street 2:
Mailing Address - City:MERCERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17236-8543
Mailing Address - Country:US
Mailing Address - Phone:717-615-6228
Mailing Address - Fax:
Practice Address - Street 1:1045 MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-7201
Practice Address - Country:US
Practice Address - Phone:301-739-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-07
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD28583225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist