Provider Demographics
NPI:1396476701
Name:VANLEYNSEELE, MAXWELL (PT, DPT)
Entity type:Individual
Prefix:
First Name:MAXWELL
Middle Name:
Last Name:VANLEYNSEELE
Suffix:
Gender:M
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 1:3719 88TH ST NE STE A
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-7228
Mailing Address - Country:US
Mailing Address - Phone:360-659-9621
Mailing Address - Fax:
Practice Address - Street 1:3719 88TH ST NE STE A
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-7228
Practice Address - Country:US
Practice Address - Phone:360-659-9621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61299655225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist