Provider Demographics
NPI:1407000557
Name:RUBIN-DELONEY, MAKKEDA (DPT)
Entity Type:Individual
Prefix:
First Name:MAKKEDA
Middle Name:
Last Name:RUBIN-DELONEY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MAKKEDA
Other - Middle Name:
Other - Last Name:RUBIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2320 E BASELINE RD STE 148-241
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85042-6960
Mailing Address - Country:US
Mailing Address - Phone:623-688-0282
Mailing Address - Fax:602-698-9278
Practice Address - Street 1:2320 E BASELINE RD STE 148-241
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-6960
Practice Address - Country:US
Practice Address - Phone:623-688-0282
Practice Address - Fax:602-698-9278
Is Sole Proprietor?:No
Enumeration Date:2008-11-14
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8677225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ132822Medicare PIN