Provider Demographics
NPI:1932723483
Name:PASEK, MACKENZIE RAE (DPT)
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:RAE
Last Name:PASEK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MACKENZIE
Other - Middle Name:RAE
Other - Last Name:ORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:170 N POINTE BLVD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-4132
Mailing Address - Country:US
Mailing Address - Phone:717-299-4871
Mailing Address - Fax:717-517-5187
Practice Address - Street 1:170 N POINTE BLVD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-4132
Practice Address - Country:US
Practice Address - Phone:717-299-4871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-01
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATPT023335225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist