Healthcare Provider Details

I. General information

NPI: 1316612476
Provider Name (Legal Business Name): MAXPERFORMGO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2021
Last Update Date: 12/14/2023
Certification Date: 12/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 PALOS VERDES MALL STE B
WALNUT CREEK CA
94597-2230
US

IV. Provider business mailing address

285 NOB HILL DR
WALNUT CREEK CA
94596-6708
US

V. Phone/Fax

Practice location:
  • Phone: 925-344-3388
  • Fax:
Mailing address:
  • Phone: 925-344-3388
  • Fax: 925-891-3502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: KRISTINE NALAGAN
Title or Position: MANAGER
Credential:
Phone: 925-344-3388