Provider Demographics
NPI:1588410393
Name:KNAPP, MACKENZIE RAE (PTA)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:RAE
Last Name:KNAPP
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:MACKENZIE
Other - Middle Name:RAE
Other - Last Name:LATTEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:1975 MCGOWAN BLVD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IA
Mailing Address - Zip Code:52302-2254
Mailing Address - Country:US
Mailing Address - Phone:319-521-9854
Mailing Address - Fax:
Practice Address - Street 1:2204 JOHNSON AVE NW
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52405-4732
Practice Address - Country:US
Practice Address - Phone:319-329-8393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA101635225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant