Provider Demographics
NPI:1194560672
Name:PASSLEY, MAKEDA
Entity type:Individual
Prefix:MISS
First Name:MAKEDA
Middle Name:
Last Name:PASSLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 S COURTHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-6256
Mailing Address - Country:US
Mailing Address - Phone:202-528-7844
Mailing Address - Fax:
Practice Address - Street 1:2 BERKELEY MEWS
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:BERMUDA
Practice Address - Zip Code:HM 13
Practice Address - Country:BM
Practice Address - Phone:202-528-7844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2251N0400X
ZZ224Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology