Provider Demographics
NPI:1417844325
Name:PARADIS, MAKENNA (PT, DPT)
Entity type:Individual
Prefix:
First Name:MAKENNA
Middle Name:
Last Name:PARADIS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9655 BRADFORD KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-9089
Mailing Address - Country:US
Mailing Address - Phone:317-626-2470
Mailing Address - Fax:
Practice Address - Street 1:204 MILL ST NE
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4500
Practice Address - Country:US
Practice Address - Phone:703-991-8156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist