Provider Demographics
NPI:1679241301
Name:SAWYER, MAXWELL EADUS (DPT)
Entity Type:Individual
Prefix:
First Name:MAXWELL
Middle Name:EADUS
Last Name:SAWYER
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 1:1600 SE J ST # 4
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-6804
Mailing Address - Country:US
Mailing Address - Phone:870-723-6645
Mailing Address - Fax:
Practice Address - Street 1:1600 SE J ST # 4
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-6804
Practice Address - Country:US
Practice Address - Phone:870-723-6645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR5050225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist