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General NPI Number Information
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NPI Number | 1902841794
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Entity Type | Organization
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Legal Business Name | PROAXIS SPARTANBURG, LLC
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Dates
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Enumeration Date | 06/17/2006
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Last Update Date | 06/04/2009
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Provider Practice Location Address
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Address Line | 333 S PINE ST
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City | SPARTANBURG
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State | SC
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Zip | 29302-2622
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Country | US
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Telephone | 864-515-7580
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Fax | 864-515-7580
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Provider Business Mailing Address
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Address Line | 125 THE PKWY SUITE 501
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City | GREENVILLE
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State | SC
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Zip | 29615-6610
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Country | US
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Telephone | 864-528-5700
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Fax | 864-528-5701
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Authorized Official
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Title or Position | VICE PRESIDENT OF ADMINISTRATION
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Name | ROBBIE LEONARD
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Credential | PT
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Telephone | 864-528-5707
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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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