Doctor Name: | KATHLEEN MADONNA MACKENNA |
NPI Number: | 1588806517 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | P.T. |
License Number: | 5501300711 |
Business Practice Address: | 17206 Van Wagoner Rd Spring Lake, MI - 494569702 |
Business Phone Number: | 6168475154 |
Business Fax Number: | 6168421949 |
Mailing Address: | 17206 Van Wagoner Rd, SPRING LAKE |
State: | MI |
Postal Code: | 494569702 |
Phone Number: | 6168475154 |
Fax Number: | 6168421949 |
NPI Enumeration Date: | 04/06/2009 |
NPI Last Update Date: | 04/06/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | 5501300711 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |