MEDICARE: DEBORAH MAXWELL

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	040.0002409	VT

General Provider Information

NPI Number	:	1710342118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH MAXWELL

Provider Business Mailing Address
First Line	:	378 PROSPECT ST
Second Line	:
City	:	BARRE
State	:	VT
Zip	:	05641-5421
Country	:	US
Telephone Number	:	802-476-4166
Fax Number	:	802-479-5679

Provider Business Practice Location Address
First Line	:	378 PROSPECT ST
Second Line	:
City	:	BARRE
State	:	VT
Zip	:	05641-5421
Country	:	US
Telephone Number	:	802-476-4166
Fax Number	:	802-479-5679

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

Provider Enumeration Date	:	12/30/2015
Last Update Date	:	12/30/2015

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Directions to “ DEBORAH MAXWELL ” Practice Location

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