Provider Demographics
NPI:1568734473
Name:MAXIDER CORPORATION
Entity Type:Organization
Organization Name:MAXIDER CORPORATION
Other - Org Name:PEAK PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PABLO
Authorized Official - Middle Name:
Authorized Official - Last Name:DER BOGHOSSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:941-894-6700
Mailing Address - Street 1:1299 BENEVA ROAD SOUTH
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-3152
Mailing Address - Country:US
Mailing Address - Phone:941-951-0283
Mailing Address - Fax:941-331-4314
Practice Address - Street 1:1299 BENEVA ROAD SOUTH
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-3152
Practice Address - Country:US
Practice Address - Phone:941-951-0283
Practice Address - Fax:941-331-4314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT0013484225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty