NPIMap

Organization Active NPI

Maximum Performance Physical Therapy, Inc.

  • Physical Therapy Clinic/Center
  • Laurel, MD
National Provider Identifier
1265809263
Registry record updated Aug 25, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
25618 Issued in MD
Legal business name
MAXIMUM PERFORMANCE PHYSICAL THERAPY, INC.
Practice address
14435 Cherry Lane CT
Laurel, MD 20707-4959
Phone
(301) 776-3665
Fax
(301) 776-6669
NPI assigned
Aug 25, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Mathias Clifford Boddicker III, DPTNPI 1770946758
Title
Physical Therapist
Phone
(302) 382-4684

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X 25618 MD Primary

Addresses

Primary practice location

14435 Cherry Lane CT
Laurel, MD 20707-4959

Mailing address

14435 Cherry Lane CT
Laurel, MD 20707-4959
Phone (301) 776-3665

National Provider Directory

National Provider Directory

Locations

14435 Cherry Lane Ct
Laurel, MD 20707
Phone (301) 776-3665

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1440460800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1440460800000",
    "number": "1265809263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14435 CHERRY LANE CT",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207074959",
            "telephone_number": "301-776-3665",
            "fax_number": "301-776-6669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14435 CHERRY LANE CT",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207074959",
            "telephone_number": "301-776-3665",
            "fax_number": "301-776-6669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAXIMUM PERFORMANCE PHYSICAL THERAPY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-25",
        "last_updated": "2015-08-25",
        "status": "A",
        "authorized_official_last_name": "BODDICKER",
        "authorized_official_first_name": "MATHIAS",
        "authorized_official_middle_name": "CLIFFORD",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "302-382-4684",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "MD",
            "license": "25618",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Laurel, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.