Provider Demographics
NPI:1730810599
Name:POWERS, MAX ROBERT
Entity type:Individual
Prefix:
First Name:MAX
Middle Name:ROBERT
Last Name:POWERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1982 SANDY BEACH RD
Mailing Address - Street 2:
Mailing Address - City:CLARION
Mailing Address - State:IA
Mailing Address - Zip Code:50525-7608
Mailing Address - Country:US
Mailing Address - Phone:515-851-8455
Mailing Address - Fax:
Practice Address - Street 1:3308 CHELSEA CIR
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-1754
Practice Address - Country:US
Practice Address - Phone:515-851-8455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-22
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer