MEDICARE: MAXIMILIAN THOMAS MAIR

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	225700000X	Massage Therapist	96308	CA

General Provider Information

NPI Number	:	1578311759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAXIMILIAN THOMAS MAIR

Provider Business Mailing Address
First Line	:	1767 MORNING ARBOR WAY
Second Line	:
City	:	SIMI VALLEY
State	:	CA
Zip	:	93065-7408
Country	:	US
Telephone Number	:	805-813-9682
Fax Number	:

Provider Business Practice Location Address
First Line	:	1767 MORNING ARBOR WAY
Second Line	:
City	:	SIMI VALLEY
State	:	CA
Zip	:	93065-7408
Country	:	US
Telephone Number	:	805-813-9682
Fax Number	:

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

Provider Enumeration Date	:	05/11/2024
Last Update Date	:	05/11/2024

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Directions to “ MAXIMILIAN THOMAS MAIR ” Practice Location

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