MEDICARE: DR. MAXWELL JAMES ARMSTRONG PT, 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	13939	WI

General Provider Information

NPI Number	:	1760971261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAXWELL JAMES ARMSTRONG PT, DPT

Provider Business Mailing Address
First Line	:	1726 SHAWANO AVE
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54303-3216
Country	:	US
Telephone Number	:	920-496-4700
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 S BROADWAY
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54303-1516
Country	:	US
Telephone Number	:	920-448-2000
Fax Number	:

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

Provider Enumeration Date	:	05/09/2018
Last Update Date	:	07/11/2018

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