Provider Demographics
NPI:1376983437
Name:MAXWELL REHABILITATION PLLC
Entity Type:Organization
Organization Name:MAXWELL REHABILITATION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:MILLER
Authorized Official - Last Name:MAXWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-920-1381
Mailing Address - Street 1:1302 N DUKE ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-1652
Mailing Address - Country:US
Mailing Address - Phone:804-920-1381
Mailing Address - Fax:
Practice Address - Street 1:1515 W PETTIGREW ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-4821
Practice Address - Country:US
Practice Address - Phone:919-286-0751
Practice Address - Fax:919-286-7065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-03
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2013-00883208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty