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General NPI Number Information
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NPI Number | 1134533615
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Entity Type | Organization
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Legal Business Name | AXIS PHYSICAL MEDICINE
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Dates
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Enumeration Date | 06/12/2014
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Last Update Date | 08/25/2014
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Provider Practice Location Address
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Address Line | 11005 S KEDZIE AVE
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City | CHICAGO
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State | IL
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Zip | 60655
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Country | US
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Telephone | 773-239-7165
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Fax |
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Provider Business Mailing Address
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Address Line | 11005 S KEDZIE AVE
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City | CHICAGO
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State | IL
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Zip | 60655
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Country | US
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Telephone | 773-239-7165
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. MICHAEL HAUSCH
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Credential | DC
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Telephone | 773-239-7165
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070020316
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License Number State | IL
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