Provider Demographics
NPI:1750500047
Name:MAKOWSKI, MARK OWEN (PT)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:OWEN
Last Name:MAKOWSKI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 PRIVATE ROAD 931
Mailing Address - Street 2:
Mailing Address - City:RICHLAND SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:76871-8815
Mailing Address - Country:US
Mailing Address - Phone:940-872-7355
Mailing Address - Fax:
Practice Address - Street 1:700 COLORADO BLVD # 318
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-4084
Practice Address - Country:US
Practice Address - Phone:866-201-9492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1138709225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist