Provider Demographics
NPI:1740790112
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:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:RICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-672-8970
Mailing Address - Street 1:14435 CHERRY LANE CT STE 100
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-4991
Mailing Address - Country:US
Mailing Address - Phone:301-776-3665
Mailing Address - Fax:
Practice Address - Street 1:5999 HARPERS FARM RD STE W100
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3015
Practice Address - Country:US
Practice Address - Phone:301-776-3665
Practice Address - Fax:301-776-6669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-11
Last Update Date:2017-10-11
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