Provider Demographics
NPI:1285793422
Name:MAXNER, ANTHONY MELVYN (PT)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:MELVYN
Last Name:MAXNER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:449 QUINAPOXET ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:MA
Mailing Address - Zip Code:01522-1461
Mailing Address - Country:US
Mailing Address - Phone:508-829-7520
Mailing Address - Fax:
Practice Address - Street 1:34 PEARLY LN
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440-1736
Practice Address - Country:US
Practice Address - Phone:978-632-1230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10305225100000X
RI1288225100000X
NH3087225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist