Provider Demographics
NPI:1124755327
Name:JOHNSON, MACKENZIE AINE (DPT)
Entity type:Individual
Prefix:DR
First Name:MACKENZIE
Middle Name:AINE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2821 NW MARKET ST STE E
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-5815
Mailing Address - Country:US
Mailing Address - Phone:206-706-0063
Mailing Address - Fax:
Practice Address - Street 1:1111 E OLIVE ST UNIT 516
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-7052
Practice Address - Country:US
Practice Address - Phone:971-285-6011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-07
Last Update Date:2022-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA612637262251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty