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Individual

MATTHEW LEE MAXON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
P.T.

Contact information

Practice address
810 E 23RD ST, SIOUX FALLS, SD 57105-2135
(605) 331-5890
(605) 336-3974
Mailing address
PO BOX 5116, SIOUX FALLS, SD 57117-5116
(605) 331-5890
(605) 336-3974

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1430
SD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1851557557
RR MEDICARE
SD
05
5836670
SD
Enumeration date
08/01/2008
Last updated
10/12/2009
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