Basic Information
| Provider Information | |||||||||
| NPI: | 1861600868 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MAXIMUM PERFORMANCE PHYSICAL THERAPY, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14504 GREENVIEW DR STE 106 | ||||||||
| Address2: | |||||||||
| City: | LAUREL | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207084224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017763665 | ||||||||
| FaxNumber: | 3017766669 | ||||||||
| Practice Location | |||||||||
| Address1: | 14504 GREENVIEW DR STE 106 | ||||||||
| Address2: | |||||||||
| City: | LAUREL | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207084224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017763665 | ||||||||
| FaxNumber: | 3017766669 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2007 | ||||||||
| LastUpdateDate: | 10/28/2022 | ||||||||
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| AuthorizedOfficialLastName: | RICH | ||||||||
| AuthorizedOfficialFirstName: | KEVIN | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 3017763665 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.