Provider Demographics
NPI:1316596422
Name:LANGEVIN, MAXWELL JOSEPH (DPT)
Entity type:Individual
Prefix:MR
First Name:MAXWELL
Middle Name:JOSEPH
Last Name:LANGEVIN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:869 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-2867
Mailing Address - Country:US
Mailing Address - Phone:207-854-1239
Mailing Address - Fax:
Practice Address - Street 1:1265 SGT JON STILES DR UNIT D
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129-2266
Practice Address - Country:US
Practice Address - Phone:303-274-7332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-11
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO16633225100000X
ME6942225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist