Provider Demographics
NPI:1467988501
Name:SHIPPEN, MAXWELL (DPT)
Entity Type:Individual
Prefix:DR
First Name:MAXWELL
Middle Name:
Last Name:SHIPPEN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 LITTLETON RD STE 1B
Mailing Address - Street 2:
Mailing Address - City:WESTFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01886-3530
Mailing Address - Country:US
Mailing Address - Phone:978-496-8217
Mailing Address - Fax:978-496-9318
Practice Address - Street 1:234 LITTLETON RD STE 1B
Practice Address - Street 2:
Practice Address - City:WESTFORD
Practice Address - State:MA
Practice Address - Zip Code:01886-3530
Practice Address - Country:US
Practice Address - Phone:978-496-8217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA22619225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist