Provider Demographics
NPI:1679548465
Name:FITTON, MAKINDRA L (DPT)
Entity type:Individual
Prefix:DR
First Name:MAKINDRA
Middle Name:L
Last Name:FITTON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:MAKINDRA
Other - Middle Name:L
Other - Last Name:WINTERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:800 SW 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-1902
Mailing Address - Country:US
Mailing Address - Phone:503-221-0161
Mailing Address - Fax:
Practice Address - Street 1:9250 SW HALL BLVD
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-6721
Practice Address - Country:US
Practice Address - Phone:503-293-0161
Practice Address - Fax:503-452-3208
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4983225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR004583012OtherBLUE CROSS
OR004583012OtherBLUE CROSS