Provider Demographics
NPI:1508500083
Name:MAXWELL, BRYNLEIGH D (PT)
Entity Type:Individual
Prefix:
First Name:BRYNLEIGH
Middle Name:D
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:BRYNLEIGH
Other - Middle Name:D
Other - Last Name:JENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2122 YORK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1925
Mailing Address - Country:US
Mailing Address - Phone:630-575-6250
Mailing Address - Fax:
Practice Address - Street 1:1044 SAGAMORE PKWY W UNIT A
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906-1446
Practice Address - Country:US
Practice Address - Phone:765-250-4445
Practice Address - Fax:765-463-7664
Is Sole Proprietor?:No
Enumeration Date:2022-04-21
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist