Provider Demographics
NPI:1588097737
Name:MAXWELL, ANGELA LYNN (PT, DPT)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:LYNN
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:LYNN
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:4701 S 19TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1199
Mailing Address - Country:US
Mailing Address - Phone:253-212-3620
Mailing Address - Fax:253-301-2088
Practice Address - Street 1:4701 S 19TH ST STE 100
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1199
Practice Address - Country:US
Practice Address - Phone:253-212-3620
Practice Address - Fax:253-301-2088
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-12
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60364087225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2201526Medicaid