Healthcare Provider Details

I. General information

NPI: 1386879559
Provider Name (Legal Business Name): MAKOVICKA HARMS GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2009
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4235 N 90TH ST
OMAHA NE
68134-4136
US

IV. Provider business mailing address

PO BOX 34669
OMAHA NE
68134-0669
US

V. Phone/Fax

Practice location:
  • Phone: 402-934-0045
  • Fax: 402-934-6562
Mailing address:
  • Phone: 402-932-6791
  • Fax: 402-614-7835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. JOEL P MAKOVICKA
Title or Position: PRESIDENT
Credential: DPT
Phone: 402-934-0045