Provider Demographics
NPI:1336611094
Name:OAK PARK MAX CARE PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:OAK PARK MAX CARE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-341-3328
Mailing Address - Street 1:12702 W 9 MILE RD
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-2959
Mailing Address - Country:US
Mailing Address - Phone:248-951-2208
Mailing Address - Fax:248-951-2219
Practice Address - Street 1:12702 W 9 MILE RD
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-2959
Practice Address - Country:US
Practice Address - Phone:248-951-2208
Practice Address - Fax:248-951-2219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-19
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy