Provider Demographics
NPI:1043527468
Name:MAXWELL, MARIANNA LEIGH (DPT)
Entity type:Individual
Prefix:
First Name:MARIANNA
Middle Name:LEIGH
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24630 WASHINGTON AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-6177
Mailing Address - Country:US
Mailing Address - Phone:951-696-9353
Mailing Address - Fax:951-973-7216
Practice Address - Street 1:38605 CALISTOGA DR
Practice Address - Street 2:SUITE 140
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-4820
Practice Address - Country:US
Practice Address - Phone:951-304-0879
Practice Address - Fax:951-304-1459
Is Sole Proprietor?:No
Enumeration Date:2010-09-07
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT37070225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0268785OtherDEPT OF LABOR AND INDUSTRIES
CAEF970WMedicare PIN
WA0268785OtherDEPT OF LABOR AND INDUSTRIES