Provider Demographics
NPI:1144871856
Name:MAXIMUM FITNESS, LLC
Entity type:Organization
Organization Name:MAXIMUM FITNESS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL OPERATIONS DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:CONNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:707-310-2524
Mailing Address - Street 1:201 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-3905
Mailing Address - Country:US
Mailing Address - Phone:707-447-0606
Mailing Address - Fax:707-447-7684
Practice Address - Street 1:201 MAIN ST
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-3905
Practice Address - Country:US
Practice Address - Phone:707-447-0606
Practice Address - Fax:707-447-7684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-24
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapistGroup - Single Specialty