Provider Demographics
NPI:1154569085
Name:NEGGO, MAXIM (DPT)
Entity type:Individual
Prefix:
First Name:MAXIM
Middle Name:
Last Name:NEGGO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4341 PIEDMONT AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-4792
Mailing Address - Country:US
Mailing Address - Phone:510-547-1630
Mailing Address - Fax:510-923-1944
Practice Address - Street 1:4341 PIEDMONT AVE STE 201
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-4792
Practice Address - Country:US
Practice Address - Phone:510-547-1630
Practice Address - Fax:510-923-1944
Is Sole Proprietor?:No
Enumeration Date:2009-01-30
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35346225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist