MEDICARE: PAXXON HEALTHCARE SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist
2	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1336808146
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAXXON HEALTHCARE SERVICES LLC

Provider Business Mailing Address
First Line	:	2222 SULLIVAN TRL
Second Line	:
City	:	EASTON
State	:	PA
Zip	:	18040-7958
Country	:	US
Telephone Number	:	610-438-2020
Fax Number	:

Provider Business Practice Location Address
First Line	:	7600 SANDY ROCK PT
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80924-5222
Country	:	US
Telephone Number	:	719-960-4005
Fax Number	:

Authorized Official
Title or Position	:	SR. CREDENTIALING SPECIALIST
Name	:	KETAKI DESHMUKH
Credential	:
Telephone Number	:	610-438-2020

Provider Enumeration Date	:	12/09/2021
Last Update Date	:	04/29/2024

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