Active NPI
Maximus Kenyon, PT, DPT
- Physical Therapist
- Dallas, TX
National Provider Identifier
1649682683
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 035197
- Practice address
- 1755 Wittington PL Ste 175
Dallas, TX 75234-1927 - Phone
- (866) 221-5405
- Fax
- (866) 534-5697
- NPI assigned
- May 26, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 035197 | NY | Primary |
Addresses
Primary practice location
1755 Wittington PL Ste 175
Dallas, TX 75234-1927
Mailing address
216 John St
Ilion, NY 13357-2521
Phone (315) 867-4433
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 035197 | NY | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1401062400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1401062400000",
"number": "1649682683",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "216 JOHN ST",
"city": "ILION",
"state": "NY",
"postal_code": "133572521",
"telephone_number": "315-867-4433"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1755 WITTINGTON PL STE 175",
"city": "DALLAS",
"state": "TX",
"postal_code": "752341927",
"telephone_number": "866-221-5405",
"fax_number": "866-534-5697"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENYON",
"first_name": "MAXIMUS",
"credential": "PT, DPT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-05-26",
"last_updated": "2014-05-26",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NY",
"license": "035197",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.