Organization
MAX POTENTIAL REHAB INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASON MARTIN BS, AS, PTA (OWNER)
(865) 776-8761
Entity
Organization
Contact information
Practice address
7905 CODY LN, KNOXVILLE, TN 37938-3172
(865) 776-8761
Mailing address
7905 CODY LN, KNOXVILLE, TN 37938-3172
(865) 776-8761
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
3409
TN
302R00000X
Health Maintenance Organization
3409
TN
305R00000X
Preferred Provider Organization
Primary
3409
TN
305S00000X
Point of Service
3409
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000001518
—
TN
Enumeration date
04/27/2010
Last updated
04/27/2010
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