MEDICARE: MAX MOTION PHYSICAL THERAPY, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	225X00000X	Occupational Therapist
2	235Z00000X	Speech-Language Pathologist
3	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1700252681
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAX MOTION PHYSICAL THERAPY, LLC

Provider Business Mailing Address
First Line	:	6397 LEE HWY STE 300
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37421-2564
Country	:	US
Telephone Number	:	423-238-7217
Fax Number	:

Provider Business Practice Location Address
First Line	:	5227 ROBINHOOD VILLAGE DR
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27106-9819
Country	:	US
Telephone Number	:	336-923-0060
Fax Number	:	336-923-0063

Authorized Official
Title or Position	:	VP REVENUE CYCLE
Name	:	KEVIN JOHANNESON
Credential	:
Telephone Number	:	423-238-8923

Provider Enumeration Date	:	08/14/2015
Last Update Date	:	09/20/2017

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