MEDICARE: JOHN MAKOVICKA PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	243	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629018866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN MAKOVICKA PT

Provider Business Mailing Address
First Line	:	PO BOX 211
Second Line	:
City	:	DAVID CITY
State	:	NE
Zip	:	68632-0211
Country	:	US
Telephone Number	:	402-652-8201
Fax Number	:	402-652-8202

Provider Business Practice Location Address
First Line	:	640 W 6TH ST
Second Line	:
City	:	NORTH BEND
State	:	NE
Zip	:	68649-4430
Country	:	US
Telephone Number	:	402-652-8201
Fax Number	:	402-652-8202

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	10/01/2014

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Directions to “ JOHN MAKOVICKA PT” Practice Location

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