Provider Demographics
NPI:1629002936
Name:MAXUM PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:MAXUM PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEAD COACH
Authorized Official - Prefix:MR
Authorized Official - First Name:ANANT
Authorized Official - Middle Name:B
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:714-646-8318
Mailing Address - Street 1:740 S PLACENTIA AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-6832
Mailing Address - Country:US
Mailing Address - Phone:714-646-8318
Mailing Address - Fax:714-646-8321
Practice Address - Street 1:740 S PLACENTIA AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-6832
Practice Address - Country:US
Practice Address - Phone:714-646-8318
Practice Address - Fax:714-646-8321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2010-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA556573Medicare Oscar/Certification