Provider Demographics
NPI:1184977027
Name:MAKI, SAMANTHA ALLISON (DPT)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:ALLISON
Last Name:MAKI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 BUTTERFIELD RD STE 1600
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1211
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4703 PACIFIC HWY E
Practice Address - Street 2:STE B
Practice Address - City:FIFE
Practice Address - State:WA
Practice Address - Zip Code:98424-2620
Practice Address - Country:US
Practice Address - Phone:253-926-8202
Practice Address - Fax:253-926-8212
Is Sole Proprietor?:No
Enumeration Date:2012-10-16
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60287145225100000X
AK225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0301862OtherDEPT. OF LABOR AND INDUSTRIES
WA1184977027Medicaid
WA0301862OtherDEPT. OF LABOR AND INDUSTRIES