Healthcare Provider Details

I. General information

NPI: 1699606947
Provider Name (Legal Business Name): MAVERICK PERFORMANCE AND PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24202 PANAMA CITY BEACH PKWY APT 506
PANAMA CITY BEACH FL
32413-7308
US

IV. Provider business mailing address

24202 PANAMA CITY BEACH PKWY APT 506
PANAMA CITY BEACH FL
32413-7308
US

V. Phone/Fax

Practice location:
  • Phone: 361-688-8929
  • Fax:
Mailing address:
  • Phone: 361-688-8929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. COLBY COURVILLE
Title or Position: OWNER
Credential: PT, DPT
Phone: 361-688-8929