Provider Demographics
NPI:1881464261
Name:MACKSEY, ELIZABETH NICOLE (PT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:NICOLE
Last Name:MACKSEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05250-8584
Mailing Address - Country:US
Mailing Address - Phone:802-681-8900
Mailing Address - Fax:
Practice Address - Street 1:38600 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-4483
Practice Address - Country:US
Practice Address - Phone:661-382-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040.0134464225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist