Healthcare Provider Details

I. General information

NPI: 1063784148
Provider Name (Legal Business Name): PAXXON HEALTHCARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2012
Last Update Date: 11/08/2022
Certification Date: 11/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 MADISON ST
OAK PARK IL
60302-4449
US

IV. Provider business mailing address

2222 SULLIVAN TRL
EASTON PA
18040-7958
US

V. Phone/Fax

Practice location:
  • Phone: 708-848-7200
  • Fax:
Mailing address:
  • Phone: 610-438-2020
  • Fax: 610-438-2024

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: RANDALL A WESTON
Title or Position: CEO
Credential: OTR/L
Phone: 484-239-2963