Healthcare Provider Details

I. General information

NPI: 1912594243
Provider Name (Legal Business Name): AXES PHYSICAL THERAPY I, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2020
Last Update Date: 12/21/2020
Certification Date: 12/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 SILO DR
UNION MO
63084-4917
US

IV. Provider business mailing address

4273 KEATON CROSSING BLVD
O FALLON MO
63368-8220
US

V. Phone/Fax

Practice location:
  • Phone: 636-649-4131
  • Fax:
Mailing address:
  • Phone: 636-206-4225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: JOHN TEEPE
Title or Position: MEMBER
Credential:
Phone: 314-764-2230