Organization
MAXIMUM IMPACT PHYSICAL THERAPY SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUANA GRANADOS (AUTHORIZED OFFICIAL)
(630) 575-1980
Entity
Organization
Contact information
Practice address
6970 N ORACLE RD, SUITE 130, TUCSON, AZ 85704-4237
(520) 219-5825
(520) 219-5827
Mailing address
600 OAKMONT LN STE 600C, WESTMONT, IL 60559-5548
(630) 575-1980
(630) 928-5080
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
3616
AZ
2251E1200X
Ergonomics Physical Therapist
3616
AZ
2251H1200X
Hand Physical Therapist
5259
AZ
2251S0007X
Sports Physical Therapist
3616
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
105129
MEDICARE ID
—
01
—
127697
AHCCCS
AZ
05
—
146481
—
AZ
Enumeration date
07/27/2006
Last updated
03/22/2019
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