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General NPI Number Information
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NPI Number | 1548997372
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Entity Type | Organization
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Legal Business Name | MAXIMUM IMPACT PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 08/02/2022
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Last Update Date | 08/02/2022
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Provider Practice Location Address
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Address Line | 10555 MONTGOMERY BLVD NE STE 30
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-3857
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Country | US
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Telephone | 505-336-4254
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Fax | 505-393-3955
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Provider Business Mailing Address
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Address Line | 5604 PLANETA CT NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-1416
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Country | US
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Telephone | 505-363-4038
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Fax | 505-393-3955
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | DR. SHYLA MESCH
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Credential | DPT
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Telephone | 505-363-4038
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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 |
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License Number State |
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