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General NPI Number Information
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NPI Number | 1215242102
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Entity Type | Organization
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Legal Business Name | AXIS PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 08/16/2010
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Last Update Date | 09/09/2010
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Provider Practice Location Address
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Address Line | 45 CAREY AVE SUITE 300
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City | BUTLER
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State | NJ
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Zip | 07405-1475
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Country | US
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Telephone | 973-291-8920
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Fax | 973-291-8929
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Provider Business Mailing Address
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Address Line | 5 JUDITH CT
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City | POMPTON PLAINS
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State | NJ
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Zip | 07444-1234
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Country | US
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Telephone | 201-259-7644
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | MR. LEONARD PIERRO JR.
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Credential | P.T.
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Telephone | 201-259-7644
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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 | 40QA00548300
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License Number State | NJ
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