Healthcare Provider Details

I. General information

NPI: 1629343991
Provider Name (Legal Business Name): PAXXON HEALTHCARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2012
Last Update Date: 01/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3575 N MOORPARK RD
THOUSAND OAKS CA
91360-2666
US

IV. Provider business mailing address

10 NEW KING ST SUITE 160
WHITE PLAINS NY
10604-1205
US

V. Phone/Fax

Practice location:
  • Phone: 805-380-4956
  • Fax: 805-380-4975
Mailing address:
  • Phone: 914-390-9880
  • Fax: 914-390-9881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: SUSAN WILLIAMSON
Title or Position: PRESIDENT
Credential: MHA, MA, ATC
Phone: 516-492-5757