| Organization Name: | MAX PERFORMANCE PHYSICAL THERAPY AND SPORTS REHAB, LLC |
| NPI Number: | 1508928300 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ALICE CREQUE (DIRECTOR OWNER) |
| Mailing Address: | 141 Stonecrest Rd Unit 2 Shelbyville |
| State: | KY US |
| Postal Code: | 40065 |
| Phone Number: | 5026470133 |
| Fax Number: | 5026470138 |
| NPI Enumeration Date: | 12/15/2006 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 004464 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KY |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |