Provider Demographics
NPI:1669501615
Name:MAXIDER CORPORATION
Entity Type:Organization
Organization Name:MAXIDER CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BLANK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:941-228-6734
Mailing Address - Street 1:2970 UNIVERSITY PKWY STE 105
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-2401
Mailing Address - Country:US
Mailing Address - Phone:941-360-1988
Mailing Address - Fax:941-360-1998
Practice Address - Street 1:2970 UNIVERSITY PKWY STE 105
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-2401
Practice Address - Country:US
Practice Address - Phone:941-360-1988
Practice Address - Fax:941-360-1998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT13467225100000X, 2251G0304X, 2251S0007X, 2251X0800X
FLPT19653225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatricsGroup - Single Specialty
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Single Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL244956206OtherUNITED HEALTH CARE
FL7042130OtherAETNA GROUP NUMBER
FLY903ROtherBLUE CROSS GROUP NUMBER
FLK1357AMedicare ID - Type UnspecifiedMEDICARE GROUP NUMBER