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General NPI Number Information
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NPI Number | 1790328045
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Entity Type | Organization
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Legal Business Name | AXIS PHYSIOTHERAPY INSTITUTE, LLC
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Dates
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Enumeration Date | 10/18/2019
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Last Update Date | 10/23/2019
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Provider Practice Location Address
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Address Line | 339 RACETRACK RD NW STE 18&20
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City | FORT WALTON BEACH
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State | FL
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Zip | 32547-1538
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Country | US
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Telephone | 850-499-9033
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Fax |
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Provider Business Mailing Address
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Address Line | 1646 PARKSIDE CIR
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City | NICEVILLE
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State | FL
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Zip | 32578-8706
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Country | US
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Telephone | 850-499-9033
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Fax |
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Authorized Official
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Title or Position | CO-OWNER/ PHYSICAL THERAPIST
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Name | DR. MATTHEW LEARY
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Credential | DPT, ATC
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Telephone | 850-499-9033
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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 |
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License Number State |
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