Provider Demographics
NPI:1912771007
Name:TUOHY, MACKENZIE MAY
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:MAY
Last Name:TUOHY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27803 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-0907
Mailing Address - Country:US
Mailing Address - Phone:248-850-7008
Mailing Address - Fax:248-657-7008
Practice Address - Street 1:27803 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-0907
Practice Address - Country:US
Practice Address - Phone:248-850-7008
Practice Address - Fax:248-657-7008
Is Sole Proprietor?:No
Enumeration Date:2023-11-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501302489225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist