Provider Demographics
NPI:1215673447
Name:TYSON, MCKENZIE LEBLANC (PT, DPT, OCS)
Entity type:Individual
Prefix:MRS
First Name:MCKENZIE
Middle Name:LEBLANC
Last Name:TYSON
Suffix:
Gender:
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:MCKENZIE
Other - Middle Name:KATE
Other - Last Name:LEBLANC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:1219 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-2347
Mailing Address - Country:US
Mailing Address - Phone:225-768-7676
Mailing Address - Fax:225-768-7373
Practice Address - Street 1:7648 PICARDY AVE STE 300
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4695
Practice Address - Country:US
Practice Address - Phone:225-768-7676
Practice Address - Fax:225-768-7373
Is Sole Proprietor?:No
Enumeration Date:2022-05-10
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11177225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist