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General NPI Number Information
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NPI Number | 1124435102
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Entity Type | Organization
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Legal Business Name | MAXIMUM POTENTIAL PHYSICAL THERAPY, PLLC
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Dates
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Enumeration Date | 07/22/2014
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Last Update Date | 07/22/2014
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Provider Practice Location Address
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Address Line | 2189 HIGHWAY 297
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City | JELLICO
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State | TN
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Zip | 37762-3416
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Country | US
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Telephone | 423-912-6085
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Fax |
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Provider Business Mailing Address
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Address Line | 2189 HIGHWAY 297
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City | JELLICO
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State | TN
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Zip | 37762-3416
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Country | US
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Telephone | 423-912-6085
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MORGAN LAY
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Credential |
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Telephone | 423-912-6085
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT0000009852
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License Number State | TN
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