MEDICARE: MARIANNA LEIGH MAXWELL DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT37070	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0268785	OTHER	WA	DEPT OF LABOR AND INDUSTRIES

General Provider Information

NPI Number	:	1043527468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIANNA LEIGH MAXWELL DPT

Provider Business Mailing Address
First Line	:	30428 HAUN RD STE 810
Second Line	:
City	:	MENIFEE
State	:	CA
Zip	:	92584-6824
Country	:	US
Telephone Number	:	951-696-9353
Fax Number	:	951-973-7216

Provider Business Practice Location Address
First Line	:	38605 CALISTOGA DR
Second Line	:	SUITE 140
City	:	MURRIETA
State	:	CA
Zip	:	92563-4820
Country	:	US
Telephone Number	:	951-304-0879
Fax Number	:	951-304-1459

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2010
Last Update Date	:	01/16/2026

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