Provider Demographics
NPI:1376383737
Name:DOYLE, MACKENZIE (DPT)
Entity type:Individual
Prefix:DR
First Name:MACKENZIE
Middle Name:
Last Name:DOYLE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:MACKENZIE
Other - Middle Name:
Other - Last Name:CHADDERDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12243 S DRAPER GATE DR APT 212
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-1904
Mailing Address - Country:US
Mailing Address - Phone:307-247-4870
Mailing Address - Fax:
Practice Address - Street 1:310 B 850 E
Practice Address - Street 2:SUITE D
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043
Practice Address - Country:US
Practice Address - Phone:801-702-8475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-31
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13967816-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist