Healthcare Provider Details

I. General information

NPI: 1669501615
Provider Name (Legal Business Name): MAXIDER CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2970 UNIVERSITY PKWY STE 105
SARASOTA FL
34243-2401
US

IV. Provider business mailing address

2970 UNIVERSITY PKWY STE 105
SARASOTA FL
34243-2401
US

V. Phone/Fax

Practice location:
  • Phone: 941-360-1988
  • Fax: 941-360-1998
Mailing address:
  • Phone: 941-360-1988
  • Fax: 941-360-1998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT13467
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License NumberPT13467
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberPT13467
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT13467
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT19653
License Number StateFL

VIII. Authorized Official

Name: JASON GRABIAK
Title or Position: PTA/OWNER
Credential: PTA
Phone: 941-360-1988