Provider Demographics
NPI:1336322387
Name:MAKBOUL, HEBA (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:HEBA
Middle Name:
Last Name:MAKBOUL
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6188 DRY HARBOR RD
Mailing Address - Street 2:APT 5E
Mailing Address - City:MIDDLE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11379
Mailing Address - Country:US
Mailing Address - Phone:646-724-3899
Mailing Address - Fax:718-424-5070
Practice Address - Street 1:6188 DRY HARBOR RD
Practice Address - Street 2:APT 5E
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379-1535
Practice Address - Country:US
Practice Address - Phone:646-724-3899
Practice Address - Fax:718-424-5070
Is Sole Proprietor?:No
Enumeration Date:2007-12-13
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY028209225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist