MEDICARE: ABBIE MARIE MAXFIELD PTA, LMT

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	225200000X	Physical Therapy Assistant	005077	IA

General Provider Information

NPI Number	:	1770915753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABBIE MARIE MAXFIELD PTA, LMT

Provider Business Mailing Address
First Line	:	434 HIGHWAY 1 W
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52246-4204
Country	:	US
Telephone Number	:	319-354-3824
Fax Number	:	319-354-3826

Provider Business Practice Location Address
First Line	:	434 HIGHWAY 1 W
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52246-4204
Country	:	US
Telephone Number	:	319-354-3824
Fax Number	:	319-354-3826

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

Provider Enumeration Date	:	08/01/2013
Last Update Date	:	08/01/2013

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