Provider Demographics
NPI:1124541016
Name:BIESSMANN, MAX (PT)
Entity Type:Individual
Prefix:
First Name:MAX
Middle Name:
Last Name:BIESSMANN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28202 CABOT RD STE 150
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-1250
Mailing Address - Country:US
Mailing Address - Phone:949-218-1848
Mailing Address - Fax:
Practice Address - Street 1:28202 CABOT RD STE 150
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-1250
Practice Address - Country:US
Practice Address - Phone:949-218-1848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT2925122251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports