Healthcare Provider Details

I. General information

NPI: 1346783727
Provider Name (Legal Business Name): MAXIMUM HEALTH & WELLNESS APOPKA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2016
Last Update Date: 04/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 S HUNT CLUB BLVD C/O RETRO FITNESS
APOPKA FL
32703-4948
US

IV. Provider business mailing address

480 S HUNT CLUB BLVD C/O RETRO FITNESS
APOPKA FL
32703-4948
US

V. Phone/Fax

Practice location:
  • Phone: 407-775-6750
  • Fax: 407-775-6752
Mailing address:
  • Phone: 407-775-6750
  • Fax: 407-775-6752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER CARROLL
Title or Position: OFFICE REP
Credential:
Phone: 352-678-3092