Provider Demographics
NPI:1558522318
Name:MAXIMUM PERFORMANCE PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:MAXIMUM PERFORMANCE PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:RICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-776-6669
Mailing Address - Street 1:14435 CHERRY LANE CT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-4959
Mailing Address - Country:US
Mailing Address - Phone:301-776-3665
Mailing Address - Fax:301-776-6669
Practice Address - Street 1:1360 BLAIR DR
Practice Address - Street 2:SUITE D
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113-1343
Practice Address - Country:US
Practice Address - Phone:410-672-8970
Practice Address - Fax:410-672-8973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-24
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19310225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4578031 01Medicaid