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Individual
MACKENZIE MALLREY ELDRIDGE
Active
Individual
MACKENZIE MALLREY ELDRIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
P17568
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P17568
PT LICENSE
NC
Enumeration date
03/06/2018
Last updated
03/06/2018
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