Provider Demographics
NPI:1912316969
Name:MEMORY PORTER MAXIMUM PHYSICAL THERAPY
Entity Type:Organization
Organization Name:MEMORY PORTER MAXIMUM PHYSICAL THERAPY
Other - Org Name:MAXIMUM PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEMORY
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:515-975-9525
Mailing Address - Street 1:817 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ADEL
Mailing Address - State:IA
Mailing Address - Zip Code:50003-1450
Mailing Address - Country:US
Mailing Address - Phone:515-993-2170
Mailing Address - Fax:515-993-2174
Practice Address - Street 1:817 MAIN ST
Practice Address - Street 2:
Practice Address - City:ADEL
Practice Address - State:IA
Practice Address - Zip Code:50003-1450
Practice Address - Country:US
Practice Address - Phone:515-993-2170
Practice Address - Fax:515-993-2174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-04
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03575261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy