Provider Demographics
NPI:1588902654
Name:MACKENZIE, ELISABETH JZYK (DPT)
Entity type:Individual
Prefix:
First Name:ELISABETH
Middle Name:JZYK
Last Name:MACKENZIE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ELISABETH
Other - Middle Name:
Other - Last Name:JZYK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:157 UNION ST
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-1228
Mailing Address - Country:US
Mailing Address - Phone:508-251-0072
Mailing Address - Fax:
Practice Address - Street 1:157 UNION ST
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-1228
Practice Address - Country:US
Practice Address - Phone:508-251-0072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-24
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17356225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist