Provider Demographics
NPI:1396355509
Name:CRAFT, MCKENZIE (PT, DPT)
Entity type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:
Last Name:CRAFT
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:MCKENZIE
Other - Middle Name:
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:
Practice Address - Street 1:804 S PIERCE ST
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:GA
Practice Address - Zip Code:31510-3506
Practice Address - Country:US
Practice Address - Phone:912-632-2667
Practice Address - Fax:913-632-2668
Is Sole Proprietor?:No
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPENDING225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist