Provider Demographics
NPI:1487418810
Name:MAX PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:MAX PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAXIM
Authorized Official - Middle Name:
Authorized Official - Last Name:TOMA
Authorized Official - Suffix:
Authorized Official - Credentials:NONE
Authorized Official - Phone:248-660-4015
Mailing Address - Street 1:28045 CARRIAGE WAY DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48051-2101
Mailing Address - Country:US
Mailing Address - Phone:248-660-4015
Mailing Address - Fax:248-548-9992
Practice Address - Street 1:28045 CARRIAGE WAY DR
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48051-2101
Practice Address - Country:US
Practice Address - Phone:248-660-4015
Practice Address - Fax:248-548-9992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy