Healthcare Provider Details

I. General information

NPI: 1043143381
Provider Name (Legal Business Name): MAKAYLA KWIEJ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 EVERGREEN RD
POTTSTOWN PA
19464-3143
US

IV. Provider business mailing address

15 LONGACRE DR
COLLEGEVILLE PA
19426-2897
US

V. Phone/Fax

Practice location:
  • Phone: 610-323-1800
  • Fax:
Mailing address:
  • Phone: 484-213-4614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberTPTA000900
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: