Provider Demographics
NPI:1932139060
Name:MACKENZIE, ALISTAIR GREGOR C (PT)
Entity Type:Individual
Prefix:MR
First Name:ALISTAIR GREGOR
Middle Name:C
Last Name:MACKENZIE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 CROSSROADS CT.
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:OH
Mailing Address - Zip Code:45377-9415
Mailing Address - Country:US
Mailing Address - Phone:937-890-9235
Mailing Address - Fax:
Practice Address - Street 1:830 FALLS CREEK DR
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:OH
Practice Address - Zip Code:45377-8600
Practice Address - Country:US
Practice Address - Phone:937-890-9235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH10596225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist