Provider Demographics
NPI:1184024812
Name:MAKINS, SARABETH JOY
Entity Type:Individual
Prefix:
First Name:SARABETH
Middle Name:JOY
Last Name:MAKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11930 WHITMORE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WHITMORE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48189-9153
Mailing Address - Country:US
Mailing Address - Phone:734-449-4649
Mailing Address - Fax:
Practice Address - Street 1:11930 WHITMORE LAKE RD
Practice Address - Street 2:
Practice Address - City:WHITMORE LAKE
Practice Address - State:MI
Practice Address - Zip Code:48189-9153
Practice Address - Country:US
Practice Address - Phone:734-449-4649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-29
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501016846225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist