Mackenzie Stack, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

Practice address

2121 S Yukon Pkwy Ste 200
Yukon, OK 73099-7482

Phone

(405) 578-5447

Fax

(866) 490-4693

NPI assigned

Feb 11, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Mackenzie Steddom Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Therawest LLC

  • Physical Therapist
  • Clinton, OK
  • NPI 1700087079
  NPD
• Therawest LLC

  • Physical Therapist
  • Clinton, OK
  • NPI 1114142486
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1581379200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744675200000",
    "number": "1023640646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3901 UNIVERSITY BLVD S",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322164312",
            "telephone_number": "904-345-7251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2121 S YUKON PKWY STE 200",
            "city": "YUKON",
            "state": "OK",
            "postal_code": "730997482",
            "telephone_number": "405-578-5447",
            "fax_number": "866-490-4693"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4800 First Coast Hwy Ste 240",
            "address_purpose": "LOCATION",
            "city": "Fernandina Beach",
            "state": "FL",
            "postal_code": "320345598",
            "country_code": "US",
            "telephone_number": "904-321-5491",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "509 S 30th St",
            "address_purpose": "LOCATION",
            "city": "Clinton",
            "state": "OK",
            "postal_code": "736013632",
            "country_code": "US",
            "telephone_number": "580-323-8778",
            "fax_number": "866-490-4693",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "424 N State St",
            "address_purpose": "LOCATION",
            "city": "Weatherford",
            "state": "OK",
            "postal_code": "730965121",
            "country_code": "US",
            "telephone_number": "580-772-8778",
            "fax_number": "866-490-4693",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "463721 State Road 200 Ste 7",
            "address_purpose": "LOCATION",
            "city": "Yulee",
            "state": "FL",
            "postal_code": "320978661",
            "country_code": "US",
            "telephone_number": "904-602-6088",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "12301 N Western Ave Ste 102",
            "address_purpose": "LOCATION",
            "city": "Oklahoma City",
            "state": "OK",
            "postal_code": "731148017",
            "country_code": "US",
            "telephone_number": "405-442-0144",
            "fax_number": "866-490-4693",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STACK",
        "first_name": "MACKENZIE",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-02-11",
        "last_updated": "2025-04-15",
        "certification_date": "2025-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MACKENZIE",
            "last_name": "STEDDOM",
            "credential": "PT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kelly Sparks, MACCCSLP
• Speech by Melissa LLC
• Speech Therapy Building Blocks
• Cristy Spencer
• SSM Healthcare of Oklahoma, Inc
• Melissa Stahlman
• Allison Staley
• Larry Stanbrough, RD,LD, CDE
• Allyson Standefer, DPT
• Samantha Stanley

• Physical Therapist in Yukon, OK
• Providers in Yukon, OK by specialty
• Physical Therapist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.