MEDICARE: MAXWELL PETIT

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	1378720	TX
2	225100000X	Physical Therapist	CP038649T	TN

General Provider Information

NPI Number	:	1467070748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAXWELL PETIT

Provider Business Mailing Address
First Line	:	1200 CORPORATE DR STE 400
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35242-5424
Country	:	US
Telephone Number	:	423-497-0005
Fax Number	:

Provider Business Practice Location Address
First Line	:	2659 8TH AVE S
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37204-2483
Country	:	US
Telephone Number	:	615-283-9009
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2020
Last Update Date	:	01/21/2025

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Directions to “ MAXWELL PETIT ” Practice Location

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