Provider Demographics
NPI:1245248285
Name:MCKENZIE, JOHN C (PT)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:C
Last Name:MCKENZIE
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 1:7 SEELEY RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302
Mailing Address - Country:US
Mailing Address - Phone:856-241-2222
Mailing Address - Fax:856-241-7961
Practice Address - Street 1:390 N BROADWAY
Practice Address - Street 2:SUITE 400
Practice Address - City:PENNSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08070
Practice Address - Country:US
Practice Address - Phone:856-678-7011
Practice Address - Fax:856-678-2820
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00171100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist