Provider Demographics
NPI:1083325344
Name:STEPHAN, MACKENZIE MARIE (DPT)
Entity type:Individual
Prefix:DR
First Name:MACKENZIE
Middle Name:MARIE
Last Name:STEPHAN
Suffix:
Gender:
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 WESTERN PL STE 501
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-4879
Mailing Address - Country:US
Mailing Address - Phone:214-351-6600
Mailing Address - Fax:
Practice Address - Street 1:6000 WESTERN PL STE 501
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-4879
Practice Address - Country:US
Practice Address - Phone:214-351-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-07
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPENDING225100000X
TX1372624225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist