Provider Demographics
NPI:1578336939
Name:MAAKESTAD, WILLIAM MATTHEW (DPT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MATTHEW
Last Name:MAAKESTAD
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:866-370-8206
Mailing Address - Fax:
Practice Address - Street 1:2625 E 62ND ST # 1012
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-3189
Practice Address - Country:US
Practice Address - Phone:317-677-0295
Practice Address - Fax:317-253-2344
Is Sole Proprietor?:No
Enumeration Date:2023-11-06
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist