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Individual

MACKENZIE ROOT

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PT, DPT, NCS

Contact information

Practice address
3303 SW BOND AVE, PORTLAND, OR 97239-4501
(503) 494-3151
Mailing address
3538 NE 44TH AVE, PORTLAND, OR 97213-1018
(541) 390-0199

Taxonomy

Speciality
Code
Description
License number
State
2251N0400X
Neurology Physical Therapist
033107
NY
2251N0400X
Neurology Physical Therapist
Primary
63285
OR

Other

Enumeration date
04/02/2020
Last updated
04/02/2020
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