Individual
CAMILLE MCKENZIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
13724 WINDING OAK CIR APT 203, CENTREVILLE, VA 20121-4766
(111) 111-1111
Mailing address
13724 WINDING OAK CIR APT 203, CENTREVILLE, VA 20121-4766
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
2305206641
VA
225100000X
Physical Therapist
Primary
P55105
NY
2251P0200X
Pediatric Physical Therapist
2305206641
VA
Other
Enumeration date
05/25/2007
Last updated
11/10/2011
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