Healthcare Provider Details

I. General information

NPI: 1841113727
Provider Name (Legal Business Name): SAMUEL MAKASIAR DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 PARK ST STE 200
NAPERVILLE IL
60563-8404
US

IV. Provider business mailing address

1755 PARK ST STE 200
NAPERVILLE IL
60563-8404
US

V. Phone/Fax

Practice location:
  • Phone: 866-525-3175
  • Fax:
Mailing address:
  • Phone: 866-525-3175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070.029658
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: