Provider Demographics
NPI:1740765932
Name:MAXWELL, SEAN A (PT,DPT)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:A
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 FONDERN ROAD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063
Mailing Address - Country:US
Mailing Address - Phone:832-252-8055
Mailing Address - Fax:832-252-8050
Practice Address - Street 1:2500 FONDERN ROAD
Practice Address - Street 2:SUITE 302
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063
Practice Address - Country:US
Practice Address - Phone:832-252-8055
Practice Address - Fax:832-252-8050
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13081532251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic