Healthcare Provider Details

I. General information

NPI: 1093272460
Provider Name (Legal Business Name): AXES PHYSICAL THERAPY I, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2019
Last Update Date: 02/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2018 PHOENIX CENTER DR
WASHINGTON MO
63090-5544
US

IV. Provider business mailing address

2018 PHOENIX CENTER DR
WASHINGTON MO
63090-5544
US

V. Phone/Fax

Practice location:
  • Phone: 314-374-8093
  • Fax:
Mailing address:
  • Phone:
  • 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: MANAGER
Credential:
Phone: 636-206-4225