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General NPI Number Information
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NPI Number | 1316612476
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Entity Type | Organization
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Legal Business Name | MAXPERFORMGO LLC
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Dates
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Enumeration Date | 08/11/2021
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Last Update Date | 12/14/2023
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Provider Practice Location Address
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Address Line | 1510 PALOS VERDES MALL STE B
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City | WALNUT CREEK
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State | CA
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Zip | 94597-2230
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Country | US
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Telephone | 925-344-3388
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Fax |
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Provider Business Mailing Address
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Address Line | 285 NOB HILL DR
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City | WALNUT CREEK
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State | CA
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Zip | 94596-6708
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Country | US
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Telephone | 925-344-3388
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Fax | 925-891-3502
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Authorized Official
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Title or Position | MANAGER
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Name | KRISTINE NALAGAN
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Credential |
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Telephone | 925-344-3388
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251S0007X
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Taxonomy Name | Sports Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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