Provider Demographics
NPI:1184300360
Name:RYLEE, MACKENZIE (PT)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:
Last Name:RYLEE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6480 HARRISON AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45247-7961
Mailing Address - Country:US
Mailing Address - Phone:513-354-7785
Mailing Address - Fax:513-354-7651
Practice Address - Street 1:1077 STATE ROUTE 28 STE 105
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150-5099
Practice Address - Country:US
Practice Address - Phone:513-653-2888
Practice Address - Fax:513-991-6600
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-23
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT020542225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist