Provider Demographics
NPI:1801365804
Name:MAKOUTZ, JASON (DPT)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:MAKOUTZ
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 1:20584 GRISTMILL CT
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-5122
Mailing Address - Country:US
Mailing Address - Phone:703-955-6996
Mailing Address - Fax:
Practice Address - Street 1:20584 GRISTMILL CT
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-5122
Practice Address - Country:US
Practice Address - Phone:703-955-6996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-31888225100000X
MT17284225100000X
AK192560225100000X
VA2305211936225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist