Provider Demographics
NPI:1427767375
Name:MANEY, MAXWELL AUSTIN (DPT)
Entity type:Individual
Prefix:
First Name:MAXWELL
Middle Name:AUSTIN
Last Name:MANEY
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:N75W23469 N RIDGEVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:SUSSEX
Mailing Address - State:WI
Mailing Address - Zip Code:53089-2067
Mailing Address - Country:US
Mailing Address - Phone:815-222-2915
Mailing Address - Fax:
Practice Address - Street 1:4545 N 92ND ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53225-4807
Practice Address - Country:US
Practice Address - Phone:414-464-3880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-18
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16155-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty