Provider Demographics
NPI:1184132979
Name:WORTHINGTON, MAKENZIE RADCLIFF (PT, DPT)
Entity type:Individual
Prefix:
First Name:MAKENZIE
Middle Name:RADCLIFF
Last Name:WORTHINGTON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10753 FALLS RD STE 235
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-4597
Mailing Address - Country:US
Mailing Address - Phone:410-583-2666
Mailing Address - Fax:410-847-3838
Practice Address - Street 1:4924 CAMPBELL BLVD STE 130A
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-5909
Practice Address - Country:US
Practice Address - Phone:443-442-2810
Practice Address - Fax:443-442-2808
Is Sole Proprietor?:No
Enumeration Date:2018-01-16
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD26797OtherBOARD OF PHYSICAL THERAPY EXAMINERS PHYSICAL THERAPIST LICENSE