Provider Demographics
NPI:1134138936
Name:MAXIMUM REHABILITATION SERVICES, LTD.
Entity Type:Organization
Organization Name:MAXIMUM REHABILITATION SERVICES, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/PHYSICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:VISHAKHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:708-923-1768
Mailing Address - Street 1:12021 S HARLEM AVE
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1139
Mailing Address - Country:US
Mailing Address - Phone:708-923-1768
Mailing Address - Fax:708-923-1773
Practice Address - Street 1:12021 S HARLEM AVE
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1139
Practice Address - Country:US
Practice Address - Phone:708-923-1768
Practice Address - Fax:708-923-1773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL060-006868225X00000X, 261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL117769037001Medicaid
IL349686576001Medicaid
IL143902846001Medicaid
IL117769037001Medicaid
IL349686576001Medicaid
IL117769037001Medicaid