Provider Demographics
NPI:1720640998
Name:MUELLER, MAKENA (PT, DPT, ATC)
Entity type:Individual
Prefix:
First Name:MAKENA
Middle Name:
Last Name:MUELLER
Suffix:
Gender:
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2717 W BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-4759
Mailing Address - Country:US
Mailing Address - Phone:719-432-6943
Mailing Address - Fax:
Practice Address - Street 1:775 S RIVERSHORE LN STE 220
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-5783
Practice Address - Country:US
Practice Address - Phone:208-629-1030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-08
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer