Basic Information
| Provider Information | |||||||||
| NPI: | 1518045780 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAXWELL | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | ROBERT | ||||||||
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| Credential: | PT | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | MAXWELL | ||||||||
| OtherFirstName: | BILL | ||||||||
| OtherMiddleName: | ROBERT | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 746 E AURORA RD | ||||||||
| Address2: | SUITE 7 | ||||||||
| City: | MACEDONIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440562732 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3309080039 | ||||||||
| FaxNumber: | 3309080211 | ||||||||
| Practice Location | |||||||||
| Address1: | 746 E AURORA RD | ||||||||
| Address2: | SUITE 7 | ||||||||
| City: | MACEDONIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440562732 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3309080039 | ||||||||
| FaxNumber: | 3309080211 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2006 | ||||||||
| LastUpdateDate: | 09/01/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 010299 | OH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.