Provider Demographics
NPI:1235730615
Name:MAXIMUM IMPACT PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:MAXIMUM IMPACT PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHYLA
Authorized Official - Middle Name:D
Authorized Official - Last Name:MESCH
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:505-363-4038
Mailing Address - Street 1:5604 PLANETA CT NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-1416
Mailing Address - Country:US
Mailing Address - Phone:505-363-4038
Mailing Address - Fax:
Practice Address - Street 1:10555 MONTGOMERY BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3857
Practice Address - Country:US
Practice Address - Phone:505-363-4038
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-03
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty