Provider Demographics
NPI:1881342749
Name:FLAHERTY, MACKENZIE JO (DPT)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:JO
Last Name:FLAHERTY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 11TH STREET PL
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:IA
Mailing Address - Zip Code:50438-1843
Mailing Address - Country:US
Mailing Address - Phone:641-860-0876
Mailing Address - Fax:
Practice Address - Street 1:848 N SUNRISE BLVD
Practice Address - Street 2:
Practice Address - City:CAMANO ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98282-8770
Practice Address - Country:US
Practice Address - Phone:360-386-7051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-10
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA113121225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist