Provider Demographics
NPI:1447958475
Name:MAKKIYA, KAMAL (ACSM CEP)
Entity type:Individual
Prefix:
First Name:KAMAL
Middle Name:
Last Name:MAKKIYA
Suffix:
Gender:M
Credentials:ACSM CEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 CLARENCE ST
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-2438
Mailing Address - Country:US
Mailing Address - Phone:413-781-0219
Mailing Address - Fax:
Practice Address - Street 1:21 CLARENCE ST
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-2438
Practice Address - Country:US
Practice Address - Phone:413-781-0219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist