Provider Demographics
NPI:1366233462
Name:PARKER, MACKENZIE RAE (PT, DPT)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:RAE
Last Name:PARKER
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 1:14844 W CIELO GRANDE AVE
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85387-7351
Mailing Address - Country:US
Mailing Address - Phone:602-615-3754
Mailing Address - Fax:
Practice Address - Street 1:28620 N EL MIRAGE RD STE B102
Practice Address - Street 2:STE B102
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-2098
Practice Address - Country:US
Practice Address - Phone:888-433-7993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-16
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-034156225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist