=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902937725
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MAXIMUM MOTION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/07/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1401 JOHNSON FERRY RD SUITE 380
-----------------------------------------------------
City | MARIETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30062-6495
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-565-9393
-----------------------------------------------------
Fax | 770-565-4544
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1401 JOHNSON FERRY RD SUITE 380
-----------------------------------------------------
City | MARIETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30062-6495
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-565-9393
-----------------------------------------------------
Fax | 770-565-4544
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICAL THERAPIST
-----------------------------------------------------
Name | MS. REBECCA A SCANNALIATO
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 770-565-9393
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT004852
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------