Healthcare Provider Details

I. General information

NPI: 1528316692
Provider Name (Legal Business Name): PHYSICAL MEDICINE OF BELLEVUE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2012
Last Update Date: 02/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 108TH AVE NE STE 1
BELLEVUE WA
98004-5578
US

IV. Provider business mailing address

555 108TH AVE NE STE 1
BELLEVUE WA
98004-5578
US

V. Phone/Fax

Practice location:
  • Phone: 425-452-9280
  • Fax: 425-452-9306
Mailing address:
  • Phone: 425-452-9280
  • Fax: 425-452-9306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH00003438
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60147179
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberAP60184962
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH60266885
License Number StateWA
# 5
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD00039986
License Number StateWA

VIII. Authorized Official

Name: DR. MIKHAIL V. MAKOVSKI
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 425-452-9280