MEDICARE: DR. EPHRAIM MAKUVE PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1658	ND
2	225100000X	Physical Therapist	PT60235492	WA
3	225100000X	Physical Therapist	8217793-2401	UT
4	225100000X	Physical Therapist	2642	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0289204	OTHER	WA	L&I
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952687584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EPHRAIM MAKUVE PT, DPT

Provider Business Mailing Address
First Line	:	820 N CHELAN AVE
Second Line	:
City	:	WENATCHEE
State	:	WA
Zip	:	98801-2028
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7470 DEAN MARTIN DR STE 101
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89139-5944
Country	:	US
Telephone Number	:	702-707-3464
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2011
Last Update Date	:	08/12/2022

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