Provider Demographics
NPI:1235978172
Name:DUMPHY, MACKENZIE HOPE
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:HOPE
Last Name:DUMPHY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 STONEHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-1208
Mailing Address - Country:US
Mailing Address - Phone:757-784-1635
Mailing Address - Fax:
Practice Address - Street 1:5424 DISCOVERY PARK BOULEVARD
Practice Address - Street 2:BUILDING B, SUITE 101
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188
Practice Address - Country:US
Practice Address - Phone:757-345-2512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2305216387225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist