Provider Demographics
NPI:1740832872
Name:MCKENZIE, DANA DOREN (PT, DPT)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:DOREN
Last Name:MCKENZIE
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 1:2069 E RANCH RD
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-3509
Mailing Address - Country:US
Mailing Address - Phone:480-206-5610
Mailing Address - Fax:
Practice Address - Street 1:612 3RD ST
Practice Address - Street 2:
Practice Address - City:LINN
Practice Address - State:KS
Practice Address - Zip Code:66953-9052
Practice Address - Country:US
Practice Address - Phone:785-348-5551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-09
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL0016447225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist