Provider Demographics
NPI:1528628906
Name:SKAR, MAKENZIE (PTA)
Entity type:Individual
Prefix:
First Name:MAKENZIE
Middle Name:
Last Name:SKAR
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 N BROOKSIDE DR APT 2404
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-4523
Mailing Address - Country:US
Mailing Address - Phone:316-303-4016
Mailing Address - Fax:
Practice Address - Street 1:1431 GREENWAY DR STE 500
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-2444
Practice Address - Country:US
Practice Address - Phone:877-688-2520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21793512081P0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPediatric Rehabilitation Medicine