Basic Information
| Provider Information | |||||||||
| NPI: | 1841739448 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCOVILL | ||||||||
| FirstName: | MACKENZIE | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 124 HAWTHORNE LN | ||||||||
| Address2: | |||||||||
| City: | GREENWOOD | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461429430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3173329861 | ||||||||
| FaxNumber: | 3178934453 | ||||||||
| Practice Location | |||||||||
| Address1: | 4040 BRYCE LANE | ||||||||
| Address2: | |||||||||
| City: | FLOWER MOUND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75077 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9402411215 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2017 | ||||||||
| LastUpdateDate: | 06/23/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1287377 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.