Healthcare Provider Details

I. General information

NPI: 1861929044
Provider Name (Legal Business Name): MEGAN MAKOUTZ DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2017
Last Update Date: 04/09/2021
Certification Date: 04/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4533 BRAMBLETON AVE
ROANOKE VA
24018-3436
US

IV. Provider business mailing address

12162 N RANCHO VISTOSO BLVD STE 120
ORO VALLEY AZ
85755-1898
US

V. Phone/Fax

Practice location:
  • Phone: 540-772-8022
  • Fax: 540-772-0294
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305211041
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: