Provider Demographics
NPI:1124349188
Name:MAXWELL, DENNIS L (LMT)
Entity type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:L
Last Name:MAXWELL
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 201
Mailing Address - Street 2:
Mailing Address - City:BAXTER
Mailing Address - State:TN
Mailing Address - Zip Code:38544-0201
Mailing Address - Country:US
Mailing Address - Phone:931-858-0507
Mailing Address - Fax:
Practice Address - Street 1:802 E 10TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-1911
Practice Address - Country:US
Practice Address - Phone:931-261-3519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-14
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8180225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist