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General NPI Number Information
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NPI Number | 1043941040
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Entity Type | Individual
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Provider Name | THERESA MAKIN
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Gender | Female
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Dates
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Enumeration Date | 06/21/2022
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Last Update Date | 06/21/2022
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Provider Practice Location Address
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Address Line | 1780 N PARK AVE STE 3
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City | MAITLAND
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State | FL
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Zip | 32751-6501
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Country | US
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Telephone | 407-676-4197
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Fax |
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Provider Business Mailing Address
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Address Line | 2522 KIOWA TRL
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City | FERN PARK
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State | FL
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Zip | 32730-3007
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Country | US
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Telephone | 407-252-8112
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA68280
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License Number State | FL
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