Provider Demographics
NPI:1518948546
Name:KLEINHANS, MAXINE B (PT CHT)
Entity Type:Individual
Prefix:
First Name:MAXINE
Middle Name:B
Last Name:KLEINHANS
Suffix:
Gender:F
Credentials:PT CHT
Other - Prefix:
Other - First Name:MAXINE
Other - Middle Name:GERTRUDE
Other - Last Name:BROCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-954-7408
Practice Address - Street 1:1130 N CHURCH ST
Practice Address - Street 2:STE 201
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1038
Practice Address - Country:US
Practice Address - Phone:336-375-4263
Practice Address - Fax:336-275-2286
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4000225100000X
NC10211002882251H1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7201114Medicaid
NC63559OtherMEDCOST
NC4968KOtherBC/BS OF NC
NC650013005OtherMEDICARE RAILROAD
NC650013005OtherMEDICARE RAILROAD