Mackenzie Katherine Bristol

Primary specialty

Pediatric Physical TherapistTaxonomy code 2251P0200X

Practice address

2108 E Boulevard
Kokomo, IN 46902-2401

Phone

(765) 416-8480

NPI assigned

Mar 27, 2024

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Ivyrehab Physical Therapy, Occupational Therapy & Speech Language Path

  • Physical Therapist
  • Peru, IN
  • NPI 1750764494

  Pediatrics

  Medicare reassignment NPD
• Ivyrehab Physical Therapy, Occupational Therapy & Speech Language Pathology, PLLC

  • Physical Medicine & Rehabilitation Physician
  • New York, NY
  • NPI 1215637699
  NPD

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

{
    "created_epoch": "1711497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711497600000",
    "number": "1548011802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 416501",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022416501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2108 E BOULEVARD",
            "city": "KOKOMO",
            "state": "IN",
            "postal_code": "469022401",
            "telephone_number": "765-416-8480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRISTOL",
        "first_name": "MACKENZIE",
        "middle_name": "KATHERINE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-03-27",
        "last_updated": "2024-03-27",
        "certification_date": "2024-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amy M Breisch, M.A., CCC-SLP
• Eric Daniel Breisch
• Jeffrey Nicholas Brentin, DO
• Rachel Bridges, FNP
• Emma Briggs
• Broadway Gentle Dentistry PC (Be Gentle Dentistry)
• Jill Brock
• Theodore W Brogan, MD
• Brookdale Senior Living Communities Inc (Sterling House of Kokomo)
• Cheyenne B Brooks, RBT

• Pediatric Physical Therapist in Kokomo, IN
• Providers in Kokomo, IN by specialty
• Pediatric Physical Therapist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.