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General NPI Number Information
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NPI Number | 1407220940
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Entity Type | Individual
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Provider Name | LUKE MAKLER DPT
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Gender | Male
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Dates
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Enumeration Date | 11/20/2015
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Last Update Date | 10/27/2022
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Provider Practice Location Address
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Address Line | 1047 CENTURY DR
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City | EDWARDSVILLE
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State | IL
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Zip | 62025-3772
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Country | US
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Telephone | 618-307-3434
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Fax | 618-307-3434
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Provider Business Mailing Address
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Address Line | 65 E WADSWORTH PARK DR STE 230
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City | DRAPER
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State | UT
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Zip | 84020-8096
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Country | US
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Telephone | 853-088-0343
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2022033276
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070021914
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License Number State | IL
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