1215673447 NPI number — MRS. MCKENZIE LEBLANC TYSON PT, DPT, OCS

Table of content: MRS. MCKENZIE LEBLANC TYSON PT, DPT, OCS (NPI 1215673447)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215673447 NPI number — MRS. MCKENZIE LEBLANC TYSON PT, DPT, OCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TYSON
Provider First Name:
MCKENZIE
Provider Middle Name:
LEBLANC
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT, OCS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LEBLANC
Provider Other First Name:
MCKENZIE
Provider Other Middle Name:
KATE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT, DPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1215673447
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/04/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1219 CHURCH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ZACHARY
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70791-2347
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-768-7676
Provider Business Mailing Address Fax Number:
225-768-7373

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7648 PICARDY AVE STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70808-4695
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-768-7676
Provider Business Practice Location Address Fax Number:
225-768-7373
Provider Enumeration Date:
05/10/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  11177 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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