Provider Demographics
NPI:1730940099
Name:MAKOWIECKI, JENNIFER (PTA)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:MAKOWIECKI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 RITCHEYS RD
Mailing Address - Street 2:
Mailing Address - City:DUNCANSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16635-5812
Mailing Address - Country:US
Mailing Address - Phone:814-414-5309
Mailing Address - Fax:
Practice Address - Street 1:1000 RITCHEYS RD
Practice Address - Street 2:
Practice Address - City:DUNCANSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16635-5812
Practice Address - Country:US
Practice Address - Phone:814-414-5309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI002831225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant