Active NPI
Mackenzie Van Loo, PT
- Physical Therapist
- Bend, OR
National Provider Identifier
1104348861
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 62296
- Practice address
- 336 SW Cyber Dr Ste 107
Bend, OR 97702 - Phone
- (541) 382-5500
- Fax
- (541) 389-5669
- NPI assigned
- Jul 13, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 62296 | OR | Primary |
Addresses
Primary practice location
336 SW Cyber Dr Ste 107
Bend, OR 97702
Mailing address
PO Box 1517
Pendleton, OR 97801-0410
Phone (877) 708-1119
Other practice location 1
2191 NW 2nd St Bldg 4
McMinnville, OR 97128-9106
Phone (503) 434-9594
Other practice location 2
2191 NW 2nd St Bldg 4
McMinnville, OR 97128-9106
Phone (503) 434-9594
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 500729554 | Medicaid | OR | |
| R195657 | Other | OR | MEDICARE |
Other names 1
- Mackenzie Curren
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1499904000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1672358400000",
"number": "1104348861",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1517",
"city": "PENDLETON",
"state": "OR",
"postal_code": "978010410",
"telephone_number": "877-708-1119",
"fax_number": "541-278-8349"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "336 SW CYBER DR STE 107",
"city": "BEND",
"state": "OR",
"postal_code": "97702",
"telephone_number": "541-382-5500",
"fax_number": "541-389-5669"
}
],
"practiceLocations": [
{
"address_1": "2191 NW 2nd St Bldg 4",
"address_purpose": "LOCATION",
"city": "McMinnville",
"state": "OR",
"postal_code": "971289106",
"country_code": "US",
"telephone_number": "503-434-9594",
"fax_number": "503-434-6808",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2191 NW 2nd St Bldg 4",
"address_purpose": "LOCATION",
"city": "McMinnville",
"state": "OR",
"postal_code": "971289106",
"country_code": "US",
"telephone_number": "503-434-9594",
"fax_number": "503-434-6808",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "VAN LOO",
"first_name": "MACKENZIE",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-07-13",
"last_updated": "2022-12-30",
"certification_date": "2022-12-30",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "OR",
"license": "62296",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "500729554",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE",
"identifier": "R195657",
"state": "OR"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "MACKENZIE",
"last_name": "CURREN",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Bend, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.