Provider Demographics
NPI:1659867661
Name:MAKO, ANITA FAITH
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:FAITH
Last Name:MAKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 TREMONT ST APT 1003
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-5052
Mailing Address - Country:US
Mailing Address - Phone:267-461-2248
Mailing Address - Fax:
Practice Address - Street 1:610 OLD YORK ROAD
Practice Address - Street 2:SUITE 400
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046
Practice Address - Country:US
Practice Address - Phone:877-504-3626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-03
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist