Provider Demographics
NPI:1518045780
Name:MAXWELL, WILLIAM ROBERT (PT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ROBERT
Last Name:MAXWELL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:BILL
Other - Middle Name:ROBERT
Other - Last Name:MAXWELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:746 E AURORA RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:MACEDONIA
Mailing Address - State:OH
Mailing Address - Zip Code:44056-2732
Mailing Address - Country:US
Mailing Address - Phone:330-908-0039
Mailing Address - Fax:330-908-0211
Practice Address - Street 1:746 E AURORA RD
Practice Address - Street 2:SUITE 7
Practice Address - City:MACEDONIA
Practice Address - State:OH
Practice Address - Zip Code:44056-2732
Practice Address - Country:US
Practice Address - Phone:330-908-0039
Practice Address - Fax:330-908-0211
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH010299225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4296181Medicare Oscar/Certification