Basic Information
| Provider Information | |||||||||
| NPI: | 1902841794 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PROAXIS SPARTANBURG, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 125 THE PKWY | ||||||||
| Address2: | SUITE 501 | ||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296156610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8645285700 | ||||||||
| FaxNumber: | 8645285701 | ||||||||
| Practice Location | |||||||||
| Address1: | 333 S PINE ST | ||||||||
| Address2: | |||||||||
| City: | SPARTANBURG | ||||||||
| State: | SC | ||||||||
| PostalCode: | 293022622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8645157580 | ||||||||
| FaxNumber: | 8645157580 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2006 | ||||||||
| LastUpdateDate: | 06/04/2009 | ||||||||
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| AuthorizedOfficialLastName: | LEONARD | ||||||||
| AuthorizedOfficialFirstName: | ROBBIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT OF ADMINISTRATION | ||||||||
| AuthorizedOfficialTelephone: | 8645285707 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.