Healthcare Provider Details

I. General information

NPI: 1629002936
Provider Name (Legal Business Name): MAXUM PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

774 S PLACENTIA AVE STE 100
PLACENTIA CA
92870-6838
US

IV. Provider business mailing address

774 S PLACENTIA AVE STE 100
PLACENTIA CA
92870-6838
US

V. Phone/Fax

Practice location:
  • Phone: 714-646-8318
  • Fax: 714-455-3656
Mailing address:
  • Phone: 714-646-8318
  • Fax: 714-455-3656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MR. ANANT B DESAI
Title or Position: HEAD COACH
Credential: PT
Phone: 714-646-8318