Provider Demographics
NPI:1831233345
Name:MAKI, BRIGID MAIRE (PT)
Entity type:Individual
Prefix:MRS
First Name:BRIGID
Middle Name:MAIRE
Last Name:MAKI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:BRIGID
Other - Middle Name:MAIRE
Other - Last Name:FARICY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3849 FEATHERSTONE CIR
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-8470
Mailing Address - Country:US
Mailing Address - Phone:651-578-1467
Mailing Address - Fax:
Practice Address - Street 1:640 JACKSON ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2502
Practice Address - Country:US
Practice Address - Phone:651-254-2071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4157225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist