Provider Demographics
NPI:1013152586
Name:MAXWELL, JESSICA L (PT, DPT, OCS)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:L
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 WETHERSFIELD RD
Mailing Address - Street 2:STE 8
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-1770
Mailing Address - Country:US
Mailing Address - Phone:508-653-6000
Mailing Address - Fax:508-653-5555
Practice Address - Street 1:4 WETHERSFIELD RD
Practice Address - Street 2:STE 8
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-1770
Practice Address - Country:US
Practice Address - Phone:508-653-6000
Practice Address - Fax:508-653-5555
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-11
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPT11102225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist