Provider Demographics
NPI:1598095846
Name:MAXWELL, TRINA (MT017810)
Entity Type:Individual
Prefix:MS
First Name:TRINA
Middle Name:
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:MT017810
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22111 EAGLE MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-4566
Mailing Address - Country:US
Mailing Address - Phone:281-727-8227
Mailing Address - Fax:281-599-3024
Practice Address - Street 1:17758 KATY FWY
Practice Address - Street 2:SUITE 4
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77094-1335
Practice Address - Country:US
Practice Address - Phone:281-727-8227
Practice Address - Fax:281-599-3024
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-09
Last Update Date:2010-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT017810225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist