Provider Demographics
NPI:1568736833
Name:MAKREDES, CONSTANTINE MICHAEL (DPT)
Entity Type:Individual
Prefix:MR
First Name:CONSTANTINE
Middle Name:MICHAEL
Last Name:MAKREDES
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:701 W CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-6015
Mailing Address - Country:US
Mailing Address - Phone:559-713-6806
Mailing Address - Fax:559-713-6809
Practice Address - Street 1:2181 HERNDON AVE STE 102
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-6309
Practice Address - Country:US
Practice Address - Phone:559-573-3430
Practice Address - Fax:559-573-3432
Is Sole Proprietor?:No
Enumeration Date:2012-03-02
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 38385225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW12026OtherGROUP PTAN