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General NPI Number Information
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NPI Number | 1487418810
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Entity Type | Organization
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Legal Business Name | MAX PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 02/07/2024
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Last Update Date | 02/07/2024
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Provider Practice Location Address
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Address Line | 28045 CARRIAGE WAY DR
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City | CHESTERFIELD
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State | MI
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Zip | 48051-2101
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Country | US
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Telephone | 248-660-4015
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Fax | 248-548-9992
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Provider Business Mailing Address
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Address Line | 28045 CARRIAGE WAY DR
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City | CHESTERFIELD
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State | MI
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Zip | 48051-2101
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Country | US
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Telephone | 248-660-4015
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Fax | 248-548-9992
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Authorized Official
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Title or Position | PRESIDENT
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Name | MAXIM TOMA
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Credential | NONE
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Telephone | 248-660-4015
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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