Provider Demographics
NPI:1245841055
Name:BALACKI, MAKENNA PAGE (PT, DPT)
Entity type:Individual
Prefix:
First Name:MAKENNA
Middle Name:PAGE
Last Name:BALACKI
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:MAKENNA
Other - Middle Name:PAGE
Other - Last Name:LOMMORI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:513 W BRIDGE ST
Mailing Address - Street 2:STE E
Mailing Address - City:YERINGTON
Mailing Address - State:NV
Mailing Address - Zip Code:89447
Mailing Address - Country:US
Mailing Address - Phone:775-463-4500
Mailing Address - Fax:775-463-4545
Practice Address - Street 1:513 W BRIDGE ST
Practice Address - Street 2:STE E
Practice Address - City:YERINGTON
Practice Address - State:NV
Practice Address - Zip Code:89447
Practice Address - Country:US
Practice Address - Phone:775-463-4500
Practice Address - Fax:775-463-4545
Is Sole Proprietor?:No
Enumeration Date:2020-08-14
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4360225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist