Provider Demographics
NPI:1669110474
Name:MAXCA INC
Entity type:Organization
Organization Name:MAXCA INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PABLO
Authorized Official - Middle Name:
Authorized Official - Last Name:DER BOGHOSSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:941-350-2239
Mailing Address - Street 1:PO BOX 5887
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34277-5887
Mailing Address - Country:US
Mailing Address - Phone:941-350-2239
Mailing Address - Fax:941-870-4915
Practice Address - Street 1:1800 CORTEZ RD W STE C
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-1335
Practice Address - Country:US
Practice Address - Phone:941-870-7473
Practice Address - Fax:941-870-4915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-23
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT13467OtherFL MEDICAL LICENSE