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NPI Code Detail

MEDICARE: TIMOTHY TODD AXTELL PT

MEDICARE: TIMOTHY TODD AXTELL PT
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
1225100000XPhysical Therapist5501009565MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1650B610090OTHERMIBCBS ID#

General Provider Information

NPI Number : 1861428328
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIMOTHY TODD AXTELL PT
Provider Business Mailing Address
First Line : 2303 WILMINGTON DR
Second Line :
City : MIDLAND
State : MI
Zip : 48642-6255
Country : US
Telephone Number : 989-778-2839
Fax Number : 989-778-2898
Provider Business Practice Location Address
First Line : 3051 KIESEL RD
Second Line :
City : BAY CITY
State : MI
Zip : 48706-2449
Country : US
Telephone Number : 989-778-2839
Fax Number : 989-778-2898
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/24/2006
Last Update Date : 07/08/2020

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