Provider Demographics
NPI:1922424142
Name:MAXIMUM PHYSICAL THERAPY AND SPORTS WELLNESS, INC
Entity Type:Organization
Organization Name:MAXIMUM PHYSICAL THERAPY AND SPORTS WELLNESS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-981-1690
Mailing Address - Street 1:2680 VALLEYDALE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-2023
Mailing Address - Country:US
Mailing Address - Phone:205-981-1690
Mailing Address - Fax:205-981-1692
Practice Address - Street 1:9330 HIGHWAY 119 STE 200
Practice Address - Street 2:
Practice Address - City:ALABASTER
Practice Address - State:AL
Practice Address - Zip Code:35007-5412
Practice Address - Country:US
Practice Address - Phone:205-624-3073
Practice Address - Fax:205-624-3043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-12
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy