Individual
DWAYNE E MAXAM
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
3518 LACLEDE, MARCHETTI EAST, ST LOUIS, MO 63103-2011
(314) 977-2323
(314) 977-7165
Mailing address
3437 CAROLINE MALL, ST LOUIS, MO 63104-1111
(314) 977-8739
(314) 977-8513
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
113728
MO
Other
Enumeration date
04/04/2006
Last updated
07/08/2007
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