Provider Demographics
NPI:1629018866
Name:MAKOVICKA, JOHN (PT)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:MAKOVICKA
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:PO BOX 211
Mailing Address - Street 2:
Mailing Address - City:DAVID CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68632-0211
Mailing Address - Country:US
Mailing Address - Phone:402-652-8201
Mailing Address - Fax:402-652-8202
Practice Address - Street 1:640 W 6TH ST
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:NE
Practice Address - Zip Code:68649-4430
Practice Address - Country:US
Practice Address - Phone:402-652-8201
Practice Address - Fax:402-652-8202
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE243225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025247500Medicaid
NE10025247500Medicaid