Provider Demographics
NPI:1700127057
Name:MCKENZIE, CELINA MAE (BCTMB, CR, CIMT)
Entity Type:Individual
Prefix:MRS
First Name:CELINA
Middle Name:MAE
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:BCTMB, CR, CIMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8240 173RD AVE SE
Mailing Address - Street 2:
Mailing Address - City:BECKER
Mailing Address - State:MN
Mailing Address - Zip Code:55308-5101
Mailing Address - Country:US
Mailing Address - Phone:612-702-1338
Mailing Address - Fax:
Practice Address - Street 1:315 WALNUT ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:MN
Practice Address - Zip Code:55362-8839
Practice Address - Country:US
Practice Address - Phone:612-702-1338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-12
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN560863-08225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist