Provider Demographics
NPI:1942891783
Name:ABERNATHY, MCKENZIE (PT, DPT)
Entity type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:
Last Name:ABERNATHY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 WOODHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-4179
Mailing Address - Country:US
Mailing Address - Phone:615-775-7177
Mailing Address - Fax:
Practice Address - Street 1:230 STONES RIVER MALL BLVD STE D
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-6312
Practice Address - Country:US
Practice Address - Phone:615-900-1202
Practice Address - Fax:615-956-7892
Is Sole Proprietor?:No
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13075225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist