Individual
MACKENZIE VAN LOO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
336 SW CYBER DR STE 107, BEND, OR 97702
(541) 382-5500
(541) 389-5669
Mailing address
PO BOX 1517, PENDLETON, OR 97801-0410
(877) 708-1119
(541) 278-8349
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
62296
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500729554
—
OR
01
—
R195657
MEDICARE
OR
Enumeration date
07/13/2017
Last updated
12/30/2022
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