Healthcare Provider Details

I. General information

NPI: 1790328045
Provider Name (Legal Business Name): AXIS PHYSIOTHERAPY INSTITUTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2019
Last Update Date: 10/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

339 RACETRACK RD NW STE 18&20
FORT WALTON BEACH FL
32547-1538
US

IV. Provider business mailing address

1646 PARKSIDE CIR
NICEVILLE FL
32578-8706
US

V. Phone/Fax

Practice location:
  • Phone: 850-499-9033
  • Fax:
Mailing address:
  • Phone: 850-499-9033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. MATTHEW LEARY
Title or Position: CO-OWNER/ PHYSICAL THERAPIST
Credential: DPT, ATC
Phone: 850-499-9033