Healthcare Provider Details

I. General information

NPI: 1417350588
Provider Name (Legal Business Name): MAXWELLNESS PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2014
Last Update Date: 10/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20025 NW 65TH CT
HIALEAH FL
33015-2138
US

IV. Provider business mailing address

20025 NW 65TH CT
HIALEAH FL
33015-2138
US

V. Phone/Fax

Practice location:
  • Phone: 954-558-3462
  • Fax:
Mailing address:
  • Phone: 954-558-3462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JEAN PASCAL PRADEL
Title or Position: DIRECTOR OF PHYSCIAL THERAPY
Credential: PT
Phone: 954-558-3462