Provider Demographics
NPI:1477381010
Name:RANDALL, MCKENZIE MARIE (DPT, PT, ATC)
Entity type:Individual
Prefix:MRS
First Name:MCKENZIE
Middle Name:MARIE
Last Name:RANDALL
Suffix:
Gender:F
Credentials:DPT, PT, ATC
Other - Prefix:
Other - First Name:KENZIE
Other - Middle Name:M
Other - Last Name:DVORACEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:34358 254TH ST
Mailing Address - Street 2:
Mailing Address - City:CHAMBERLAIN
Mailing Address - State:SD
Mailing Address - Zip Code:57325-6320
Mailing Address - Country:US
Mailing Address - Phone:605-464-1466
Mailing Address - Fax:605-234-0164
Practice Address - Street 1:200 PAUL GUST RD STE 109
Practice Address - Street 2:
Practice Address - City:CHAMBERLAIN
Practice Address - State:SD
Practice Address - Zip Code:57325-1021
Practice Address - Country:US
Practice Address - Phone:605-234-0165
Practice Address - Fax:605-234-0164
Is Sole Proprietor?:No
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1767208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation