Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA.0014502 | CO |
NPI | 1003486879 |
---|---|
Provider Name | Jeffrey Joseph Maxwell |
First Address | Thornton, CO 80241-2302 |
Second Address | Thornton, CO 80241-2302 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2021 |
Last Update Date | 25/06/2021 |