Provider Demographics
NPI:1952708562
Name:MAXWELL, ANDREW (LMP)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:MAXWELL
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 164TH ST SE
Mailing Address - Street 2:STE. N
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-6301
Mailing Address - Country:US
Mailing Address - Phone:425-319-1123
Mailing Address - Fax:
Practice Address - Street 1:800 164TH ST SE
Practice Address - Street 2:STE. N
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-6301
Practice Address - Country:US
Practice Address - Phone:425-319-1123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-25
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60498954225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist