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Organization
MAXIDER CORPORATION
Active
Organization
MAXIDER CORPORATION
Active
Other names
Excell Rehab
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PABLO EDGARDO DERBOGHOSSIAN (PRESIDENT)
(941) 488-6600
Entity
Organization
Contact information
Practice address
389 COMMERCIAL COURT, SUITE C, VENICE, FL 34292
(941) 488-6600
Mailing address
389 COMMERCIAL COURT, SUITE C, VENICE, FL 34292
(941) 488-6600
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
PT13467
FL
2251G0304X
Geriatric Physical Therapist
PT13467
FL
2251S0007X
Sports Physical Therapist
Primary
PT13467
FL
2251X0800X
Orthopedic Physical Therapist
PT13467
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7042130
AETNA NUMBER
FL
01
—
CG9065
RR MEDICARE
FL
01
—
Y903S
BLUE CROSS NUMBER
FL
Enumeration date
03/02/2007
Last updated
09/11/2025
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