Provider Demographics
NPI:1225389257
Name:MAKIRI, MARC BRADLEY (PT,RN)
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:BRADLEY
Last Name:MAKIRI
Suffix:
Gender:M
Credentials:PT,RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10000 ETON AVE
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-3031
Mailing Address - Country:US
Mailing Address - Phone:818-970-6356
Mailing Address - Fax:
Practice Address - Street 1:10000 ETON AVE
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-3031
Practice Address - Country:US
Practice Address - Phone:818-970-6356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-01
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA828371163W00000X
CAPT 23679225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No163W00000XNursing Service ProvidersRegistered Nurse