Provider Demographics
NPI:1740089093
Name:JANKOWSKI, MAKENZIE
Entity type:Individual
Prefix:DR
First Name:MAKENZIE
Middle Name:
Last Name:JANKOWSKI
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 BIRGE RD
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-3531
Mailing Address - Country:US
Mailing Address - Phone:860-940-8545
Mailing Address - Fax:
Practice Address - Street 1:893 MAIN ST STE 302
Practice Address - Street 2:
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108-2293
Practice Address - Country:US
Practice Address - Phone:860-289-6021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT14765225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist