Provider Demographics
NPI:1386675148
Name:MAKSYMIW, STEFAN T (PT)
Entity Type:Individual
Prefix:
First Name:STEFAN
Middle Name:T
Last Name:MAKSYMIW
Suffix:
Gender:M
Credentials:PT
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Other - Credentials:
Mailing Address - Street 1:3001 EDWARDS MILL RD
Mailing Address - Street 2:200
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-5243
Mailing Address - Country:US
Mailing Address - Phone:919-781-4060
Mailing Address - Fax:919-781-5246
Practice Address - Street 1:222 ASHVILLE AVE
Practice Address - Street 2:SUITE 20
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-6130
Practice Address - Country:US
Practice Address - Phone:919-863-5924
Practice Address - Fax:919-863-5923
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2015-09-14
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Provider Licenses
StateLicense IDTaxonomies
NC9789225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC079PPOtherBCBSNC
NC2506322BMedicare PIN