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NPI Code Detail

MEDICARE: MAXWELL BLAKE

MEDICARE: MAXWELL BLAKE
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
1225100000XPhysical Therapist2305212147VA

General Provider Information

NPI Number : 1023597382
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAXWELL BLAKE
Provider Business Mailing Address
First Line : 350 NEW FIDELITY CT
Second Line :
City : GARNER
State : NC
Zip : 27529-2665
Country : US
Telephone Number : 919-258-2714
Fax Number : 410-648-4878
Provider Business Practice Location Address
First Line : 1600 WILSON BLVD STE 102
Second Line :
City : ARLINGTON
State : VA
Zip : 22209-2505
Country : US
Telephone Number : 703-935-1996
Fax Number : 703-935-1995
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2018
Last Update Date : 08/08/2018

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Directions to “ MAXWELL BLAKE ” Practice Location

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