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General NPI Number Information
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NPI Number | 1063172807
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Entity Type | Organization
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Legal Business Name | NEUROAXIS REHABILITATION SERVICES
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Dates
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Enumeration Date | 12/21/2021
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Last Update Date | 02/04/2022
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Provider Practice Location Address
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Address Line | 1159 BAYBERRY DR
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City | CANONSBURG
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State | PA
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Zip | 15317-4992
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Country | US
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Telephone | 724-705-4311
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Fax |
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Provider Business Mailing Address
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Address Line | 1159 BAYBERRY DR
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City | CANONSBURG
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State | PA
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Zip | 15317-4992
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Country | US
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Telephone | 724-705-4311
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Fax |
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Authorized Official
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Title or Position | OWNER/ PHYSICAL THERAPIST
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Name | KELSEY HARRIS
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Credential | PT, DPT, RPSFC
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Telephone | 724-705-4311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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