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General NPI Number Information
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NPI Number | 1881083475
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Entity Type | Organization
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Legal Business Name | MAXWELLNESS PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 01/20/2015
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Last Update Date | 07/20/2020
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Provider Practice Location Address
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Address Line | 18600 NW 87TH AVE UNIT 126
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City | HIALEAH
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State | FL
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Zip | 33015-3536
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Country | US
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Telephone | 954-869-4310
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Fax | 954-869-4313
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Provider Business Mailing Address
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Address Line | 18600 NW 87TH AVE UNIT 126
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City | HIALEAH
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State | FL
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Zip | 33015-3536
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Country | US
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Telephone | 954-869-4310
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Fax | 954-869-4313
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Authorized Official
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Title or Position | PHYSICAL THERAPY DIRECTOR
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Name | MR. JEAN PASCAL PRADEL
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Credential | PT
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Telephone | 954-558-3462
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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 | PT20304
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License Number State | FL
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