Basic Information
| Provider Information | |||||||||
| NPI: | 1235610916 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | AXES PHYSICAL THERAPY, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | AXES PHYSICAL THERAPY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 336 FESTUS CENTRE DR | ||||||||
| Address2: | |||||||||
| City: | FESTUS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630282458 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3147184560 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 336 FESTUS CENTRE DR | ||||||||
| Address2: | |||||||||
| City: | FESTUS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630282458 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6362247511 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2018 | ||||||||
| LastUpdateDate: | 03/19/2019 | ||||||||
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| AuthorizedOfficialLastName: | TEEPE | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 3147642230 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MPT | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 335E00000X | Y | Suppliers | Prosthetic/Orthotic Supplier |
No ID Information.