Provider Demographics
NPI:1306683404
Name:HERTZ, ALLI MCKENZIE (PT)
Entity type:Individual
Prefix:
First Name:ALLI
Middle Name:MCKENZIE
Last Name:HERTZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ALLI
Other - Middle Name:MCKENZIE
Other - Last Name:MCCOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:110 MILLIONAIRE AVE
Mailing Address - Street 2:
Mailing Address - City:MOTT
Mailing Address - State:ND
Mailing Address - Zip Code:58646-7265
Mailing Address - Country:US
Mailing Address - Phone:701-690-1762
Mailing Address - Fax:701-824-4647
Practice Address - Street 1:1679 6TH AVE W
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-2904
Practice Address - Country:US
Practice Address - Phone:701-483-1000
Practice Address - Fax:701-483-1001
Is Sole Proprietor?:No
Enumeration Date:2024-07-15
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2697225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist