Healthcare Provider Details

I. General information

NPI: 1144382904
Provider Name (Legal Business Name): AXIS PHYSICAL THERAPY & REHAB INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 05/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 RIVER ROAD SUITE 102
EUGENE OR
97404
US

IV. Provider business mailing address

2401 RIVER ROAD SUITE 102
EUGENE OR
97404
US

V. Phone/Fax

Practice location:
  • Phone: 541-683-6187
  • Fax: 541-689-4525
Mailing address:
  • Phone: 541-683-6187
  • Fax: 541-689-4525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier181410
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name: MS. CHRISTINA DEANNE HOWARD
Title or Position: PRESIDENT PHYSICAL THERAPIST
Credential: MPT
Phone: 541-683-6187