Provider Demographics
NPI:1710923578
Name:MAKOWSKI, DORIT (RPT)
Entity Type:Individual
Prefix:
First Name:DORIT
Middle Name:
Last Name:MAKOWSKI
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18422 SAN JOSE ST
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91326-3420
Mailing Address - Country:US
Mailing Address - Phone:818-368-8644
Mailing Address - Fax:818-831-5355
Practice Address - Street 1:1549 W OLYMPIC BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-3806
Practice Address - Country:US
Practice Address - Phone:213-381-7478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT86282251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT8628Medicare ID - Type UnspecifiedRPT