Provider Demographics
NPI:1780106161
Name:TURK, MAKENNA LEE (MAT, LAT, ATC)
Entity type:Individual
Prefix:
First Name:MAKENNA
Middle Name:LEE
Last Name:TURK
Suffix:
Gender:M
Credentials:MAT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4132 E 16TH AVE # D318
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-2200
Mailing Address - Country:US
Mailing Address - Phone:406-239-3543
Mailing Address - Fax:
Practice Address - Street 1:5530 N 4TH ST
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-9266
Practice Address - Country:US
Practice Address - Phone:406-239-3543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-07
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDAT-7172255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
0OtherN/A