Active NPI
Mackenzie Anderson, PT
- Physical Therapist
- Racine, WI
National Provider Identifier
1740914811
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 10623-24
- Practice address
- 2408 4 Mile Rd
Racine, WI 53402-2091 - Phone
- (262) 687-5995
- NPI assigned
- Jul 13, 2022
- 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 | 10623-24 | WI | Primary |
Addresses
Primary practice location
2408 4 Mile Rd
Racine, WI 53402-2091
Mailing address
2408 4 Mile Rd
Racine, WI 53402-2091
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10623-24 | WI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1657670400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1657670400000",
"number": "1740914811",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2408 4 MILE RD",
"city": "RACINE",
"state": "WI",
"postal_code": "534022091"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2408 4 MILE RD",
"city": "RACINE",
"state": "WI",
"postal_code": "534022091",
"telephone_number": "262-687-5995"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSON",
"first_name": "MACKENZIE",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-07-13",
"last_updated": "2022-07-13",
"certification_date": "2022-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "10623-24",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Racine, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 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.