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General NPI Number Information
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NPI Number | 1891702411
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Entity Type | Organization
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Legal Business Name | PERFORMAX PHYSICAL THERAPY, INC
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Dates
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Enumeration Date | 08/03/2006
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Last Update Date | 10/27/2011
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Provider Practice Location Address
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Address Line | 1048 N. MONROE ST.
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City | MONROE
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State | MI
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Zip | 48162
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Country | US
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Telephone | 734-241-1400
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Fax | 734-241-1414
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Provider Business Mailing Address
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Address Line | 1048 N. MONROE ST.
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City | MONROE
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State | MI
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Zip | 48162
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Country | US
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Telephone | 734-241-1400
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Fax | 734-241-1414
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Authorized Official
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Title or Position | OWNER
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Name | MONICA A. MANNINO
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Credential |
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Telephone | 734-241-1400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational 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 | 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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