Healthcare Provider Details

I. General information

NPI: 1710669304
Provider Name (Legal Business Name): MAKENNA NICOLE ENSLIN-MELL DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2023
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SCRANTON CARBONDALE HWY
EYNON PA
18403-1029
US

IV. Provider business mailing address

200 SCRANTON CARBONDALE HWY
EYNON PA
18403-1029
US

V. Phone/Fax

Practice location:
  • Phone: 570-291-8563
  • Fax:
Mailing address:
  • Phone: 570-291-8563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT031476
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: