Basic Information
| Provider Information | |||||||||
| NPI: | 1093312241 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AXES PHYSICAL THERAPY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4273 KEATON CROSSING BLVD | ||||||||
| Address2: | |||||||||
| City: | O FALLON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 633688220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6362064225 | ||||||||
| FaxNumber: | 6364221051 | ||||||||
| Practice Location | |||||||||
| Address1: | 7483 MEXICO RD | ||||||||
| Address2: | |||||||||
| City: | SAINT PETERS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 633761304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6362063654 | ||||||||
| FaxNumber: | 6363876105 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/01/2020 | ||||||||
| LastUpdateDate: | 10/01/2020 | ||||||||
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| AuthorizedOfficialLastName: | TEEPE | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 3147642230 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MPT | ||||||||
| NPICertificationDate: | 10/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.