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General NPI Number Information
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NPI Number | 1912456799
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Entity Type | Organization
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Legal Business Name | AXIOMHEALTH MANAGEMENT LLC
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Dates
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Enumeration Date | 09/22/2016
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Last Update Date | 09/10/2025
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Provider Practice Location Address
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Address Line | 1180 SPRING CENTRE SOUTH BLVD STE 225
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32714-1991
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Country | US
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Telephone | 407-494-0644
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Fax | 407-494-0644
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Provider Business Mailing Address
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Address Line | 1180 SPRING CENTRE SOUTH BLVD STE 225
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32714-1991
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Country | US
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Telephone | 407-495-1165
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Fax | 407-494-0644
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Authorized Official
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Title or Position | REGISTERED AGENT
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Name | MR. DUSTIN PATRIC MOURA
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Credential | PTA
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Telephone | 407-388-8866
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number |
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License Number State |
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Taxonomy #5
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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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Taxonomy #6
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 2251G0304X
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Taxonomy Name | Geriatric Physical Therapist
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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