Healthcare Provider Details

I. General information

NPI: 1871544577
Provider Name (Legal Business Name): MAX WELL THERAPY L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 11/15/2022
Certification Date: 11/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1289 S LINDEN RD STE A
FLINT MI
48532-3499
US

IV. Provider business mailing address

1289 S LINDEN RD STE A
FLINT MI
48532-3499
US

V. Phone/Fax

Practice location:
  • Phone: 810-230-9750
  • Fax: 810-230-8799
Mailing address:
  • Phone: 810-230-9750
  • Fax: 810-230-8799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. JILLAYNE M MAXWELL
Title or Position: OWNER
Credential: PT
Phone: 810-230-9750