Basic Information
| Provider Information | |||||||||
| NPI: | 1487271235 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VERMEIRE | ||||||||
| FirstName: | MCKENZIE | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4699 PINE ST | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681062519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4029683263 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3516 N 163RD PLZ STE 3 | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681162112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4029683263 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2020 | ||||||||
| LastUpdateDate: | 06/28/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 11852 | MN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.