Individual
JILLAYNE MARIA MAXWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4425
MN
225100000X
Physical Therapist
5501004033
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
018K1MA
BCBS
MN
05
—
059296000
—
MN
01
—
0B557040
BCBS
MI
05
—
438-3090
—
MI
Enumeration date
07/08/2006
Last updated
03/07/2022
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