=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134138936
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MAXIMUM REHABILITATION SERVICES, LTD.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/08/2006
-----------------------------------------------------
Last Update Date | 04/06/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12021 S HARLEM AVE
-----------------------------------------------------
City | PALOS HEIGHTS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60463-1139
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-923-1768
-----------------------------------------------------
Fax | 708-923-1773
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12021 S HARLEM AVE
-----------------------------------------------------
City | PALOS HEIGHTS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60463-1139
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-923-1768
-----------------------------------------------------
Fax | 708-923-1773
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR/PHYSICAL THERAPIST
-----------------------------------------------------
Name | MS. VISHAKHA SHAH
-----------------------------------------------------
Credential | RPT
-----------------------------------------------------
Telephone | 708-923-1768
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number | 060-006868
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 060-006868
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------