Provider Demographics
NPI:1881647337
Name:MAX WELL THERAPY LLC
Entity Type:Organization
Organization Name:MAX WELL THERAPY LLC
Other - Org Name:MAX WELL PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:M
Authorized Official - Last Name:MAXWELL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:952-440-5906
Mailing Address - Street 1:14033 COMMERCE AVE NE
Mailing Address - Street 2:
Mailing Address - City:PRIOR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55372-1438
Mailing Address - Country:US
Mailing Address - Phone:952-440-5906
Mailing Address - Fax:952-440-5907
Practice Address - Street 1:14033 COMMERCE AVE NE
Practice Address - Street 2:
Practice Address - City:PRIOR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55372-1438
Practice Address - Country:US
Practice Address - Phone:952-440-5906
Practice Address - Fax:952-440-5907
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAX WELL THERAPY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-18
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNAETNAOther7368023
MN018K0MAOtherGROUP #
MN1819187OtherAMERICAS PPO
MNAETNAOther7368023