Provider Demographics
NPI:1801291125
Name:MCKENZIE, STEPHEN (DPT)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:
Last Name:MCKENZIE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2247 W GREAT NECK RD STE 101
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-1556
Mailing Address - Country:US
Mailing Address - Phone:757-742-3778
Mailing Address - Fax:757-585-3787
Practice Address - Street 1:2247 W GREAT NECK RD STE 101
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-1556
Practice Address - Country:US
Practice Address - Phone:757-742-3778
Practice Address - Fax:757-585-3787
Is Sole Proprietor?:No
Enumeration Date:2014-10-29
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305206923225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist