Healthcare Provider Details

I. General information

NPI: 1891702411
Provider Name (Legal Business Name): PERFORMAX PHYSICAL THERAPY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 10/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1048 N. MONROE ST.
MONROE MI
48162
US

IV. Provider business mailing address

1048 N. MONROE ST.
MONROE MI
48162
US

V. Phone/Fax

Practice location:
  • Phone: 734-241-1400
  • Fax: 734-241-1414
Mailing address:
  • Phone: 734-241-1400
  • Fax: 734-241-1414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MONICA A. MANNINO
Title or Position: OWNER
Credential:
Phone: 734-241-1400