Healthcare Provider Details

I. General information

NPI: 1780825455
Provider Name (Legal Business Name): AXCESS PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2009
Last Update Date: 07/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 N SCHUYLER AVE
KANKAKEE IL
60901-3828
US

IV. Provider business mailing address

141 N SCHUYLER AVE
KANKAKEE IL
60901-3828
US

V. Phone/Fax

Practice location:
  • Phone: 815-614-2100
  • Fax: 815-614-2101
Mailing address:
  • Phone: 815-614-2100
  • Fax: 815-614-2101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number070012917
License Number StateIL

VIII. Authorized Official

Name: DR. AARON W FUERST
Title or Position: OWNER
Credential: DPT
Phone: 815-549-6587