MEDICARE: AXXESS THERAPY PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	ME74255	FL
2	208VP0014X	Interventional Pain Medicine Physician	ME107880	FL

General Provider Information

NPI Number	:	1366843625
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AXXESS THERAPY PLLC

Provider Business Mailing Address
First Line	:	6160 SW HIGHWAY 200
Second Line	:	UNIT 119
City	:	OCALA
State	:	FL
Zip	:	34476-8307
Country	:	US
Telephone Number	:	352-694-6331
Fax Number	:	352-694-6338

Provider Business Practice Location Address
First Line	:	6160 SW HIGHWAY 200
Second Line	:	UNIT 119
City	:	OCALA
State	:	FL
Zip	:	34476-8307
Country	:	US
Telephone Number	:	352-694-6331
Fax Number	:	352-694-6338

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	CHARLETTE BURLESON
Credential	:
Telephone Number	:	352-694-6331

Provider Enumeration Date	:	09/05/2014
Last Update Date	:	09/05/2014

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Directions to “AXXESS THERAPY PLLC ” Practice Location

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