Individual
NOAH D MAXWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
5521 W STATE ST, BOISE, ID 83703-3337
(208) 853-6220
(208) 853-0554
Mailing address
5521 W STATE ST, BOISE, ID 83703-3337
(208) 853-6220
(208) 853-0554
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-2140
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8079161
—
ID
01
—
P00443133
RETIRED RAILROAD MEDICARE
ID
Enumeration date
12/01/2006
Last updated
04/06/2010
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