Provider Demographics
NPI:1770316689
Name:KUSHMA, MACKENZIE (ATC)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:
Last Name:KUSHMA
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 MAGGIE LN
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:PA
Mailing Address - Zip Code:16143-1741
Mailing Address - Country:US
Mailing Address - Phone:724-651-5418
Mailing Address - Fax:
Practice Address - Street 1:149 MAGGIE LN
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:PA
Practice Address - Zip Code:16143-1741
Practice Address - Country:US
Practice Address - Phone:724-651-5418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-26
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer