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General NPI Number Information
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NPI Number | 1477103695
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Entity Type | Individual
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Provider Name | MAXWELL DUNFEY
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Gender | Male
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Dates
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Enumeration Date | 09/19/2019
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Last Update Date | 09/05/2024
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Provider Practice Location Address
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Address Line | 34 OLEANDER DR
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City | CLAYTON
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State | NC
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Zip | 27527-4599
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Country | US
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Telephone | 919-803-0738
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Fax | 919-882-1727
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Provider Business Mailing Address
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Address Line | 8470 FALLS OF NEUSE RD STE 100
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City | RALEIGH
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State | NC
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Zip | 27615-3550
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Country | US
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Telephone | 919-803-0738
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Fax | 919-882-1727
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | P19096
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License Number State | NC
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Legacy Identifiers
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Identifier #1
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Identifier Code | P19096
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Identifier Type | OTHER
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Identifier State | NC
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Identifier Issuer | PHYSICAL THERAPY LICENSE
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Proprietary Identifiers Ever Reported
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Identifier #1
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Identifier Code | P19096
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Identifier Type | OTHER
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Identifier State | NC
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Identifier Issuer | PHYSICAL THERAPY LICENSE
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Identifier #2
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Identifier Code | P19096
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Identifier Type | OTHER
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Identifier State | NY
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Identifier Issuer | NC PT LICENSE
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