Provider Demographics
NPI:1710577549
Name:THE MAX THERAPY CENTER, LLC
Entity Type:Organization
Organization Name:THE MAX THERAPY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:256-810-8290
Mailing Address - Street 1:101 E ELM ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:KS
Mailing Address - Zip Code:66725-1820
Mailing Address - Country:US
Mailing Address - Phone:620-429-4629
Mailing Address - Fax:
Practice Address - Street 1:101 E ELM ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:KS
Practice Address - Zip Code:66725-1820
Practice Address - Country:US
Practice Address - Phone:256-810-8290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-25
Last Update Date:2021-06-23
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
KS1013241108Medicaid