Provider Demographics
NPI:1942833488
Name:SCHMITT, MAKANNA (PTA)
Entity Type:Individual
Prefix:
First Name:MAKANNA
Middle Name:
Last Name:SCHMITT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1051 22ND RD
Mailing Address - Street 2:
Mailing Address - City:ULYSSES
Mailing Address - State:NE
Mailing Address - Zip Code:68669-6997
Mailing Address - Country:US
Mailing Address - Phone:402-367-8714
Mailing Address - Fax:
Practice Address - Street 1:510 BRADFORD ST STE B
Practice Address - Street 2:
Practice Address - City:SEWARD
Practice Address - State:NE
Practice Address - Zip Code:68434-1709
Practice Address - Country:US
Practice Address - Phone:402-646-2007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1711225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant