Provider Demographics
NPI:1871589895
Name:MAKI, JENNIFER LYNN (DPT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:MAKI
Suffix:
Gender:F
Credentials:DPT
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Mailing Address - Street 1:WASATCH PHYSICAL THERAPY & SPORTS MEDICINE AT PARK CITY
Mailing Address - Street 2:597 PARKWAY DR. STE C
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098
Mailing Address - Country:US
Mailing Address - Phone:435-649-7335
Mailing Address - Fax:435-649-7568
Practice Address - Street 1:WASATCH PHYSICAL THERAPY & SPORTS MEDICINE AT PARK CITY
Practice Address - Street 2:597 PARKWAY DR. STE C
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098
Practice Address - Country:US
Practice Address - Phone:435-649-7335
Practice Address - Fax:435-649-7568
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-26
Last Update Date:2018-10-05
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Provider Licenses
StateLicense IDTaxonomies
CO11482225100000X
OH225100000X
UT9346013-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist