MEDICARE: MAXIMIZE PHYSICAL THERAPY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1316607963
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAXIMIZE PHYSICAL THERAPY, LLC

Provider Business Mailing Address
First Line	:	117 LAKE ST
Second Line	:
City	:	WILMINGTON
State	:	MA
Zip	:	01887-1632
Country	:	US
Telephone Number	:	617-697-8401
Fax Number	:

Provider Business Practice Location Address
First Line	:	117 LAKE ST
Second Line	:
City	:	WILMINGTON
State	:	MA
Zip	:	01887-1632
Country	:	US
Telephone Number	:	617-697-8401
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	ADELE DE ANGELIS
Credential	:	MSPT
Telephone Number	:	617-697-8401

Provider Enumeration Date	:	12/22/2021
Last Update Date	:	03/31/2022

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