Healthcare Provider Details

I. General information

NPI: 1427740927
Provider Name (Legal Business Name): MAXWELL PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2023
Last Update Date: 05/23/2023
Certification Date: 05/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6285 N KNOX AVE
CHICAGO IL
60646-5032
US

IV. Provider business mailing address

909 W EUCLID AVE UNIT 853
ARLINGTON HEIGHTS IL
60006-2134
US

V. Phone/Fax

Practice location:
  • Phone: 773-499-9313
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MAXWELL SCOTT JANCZAK
Title or Position: FOUNDER
Credential: PT, DPT
Phone: 773-499-9313