Healthcare Provider Details

I. General information

NPI: 1851815765
Provider Name (Legal Business Name): ROMAN MAKAROV DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2017
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1341 ORANGE AVE
WINTER PARK FL
32789-4909
US

IV. Provider business mailing address

1341 ORANGE AVE
WINTER PARK FL
32789-4909
US

V. Phone/Fax

Practice location:
  • Phone: 407-691-7687
  • Fax:
Mailing address:
  • Phone: 407-691-7687
  • Fax: 407-691-7697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT32566
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: