Healthcare Provider Details

I. General information

NPI: 1184390106
Provider Name (Legal Business Name): AXIS ORTHOTICS AND PROSTHETICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2021
Last Update Date: 10/06/2021
Certification Date: 10/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11261 RICHMOND AVE BLDG. G, STE. 102
HOUSTON TX
77082-2676
US

IV. Provider business mailing address

11261 RICHMOND AVE, BLDG. G, STE 102
HOUSTON TX
77082-2676
US

V. Phone/Fax

Practice location:
  • Phone: 281-809-3600
  • Fax: 281-809-3007
Mailing address:
  • Phone: 281-809-3600
  • Fax: 281-809-3007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM E HEARN
Title or Position: MANAGER
Credential: C.O., L.P.O.
Phone: 281-809-3600