Individual
KELLY L MACKENZIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
555 E BROADWAY AVE # 100, JACKSON, WY 83001-8640
(208) 709-2018
Mailing address
555 E BROADWAY AVE # 100, JACKSON, WY 83001-8640
(208) 709-2018
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-2544
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT2544
LICENSE
WY
Enumeration date
10/17/2025
Last updated
10/17/2025
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