Individual
STEPHANIE MARIE LYLE MAXWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
395 S PRATT PKWY, LONGMONT, CO 80501-6436
(303) 776-6200
Mailing address
395 S PRATT PKWY, LONGMONT, CO 80501-6499
(303) 776-6200
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
10142
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
CO
Enumeration date
11/07/2008
Last updated
04/05/2024
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