Provider Demographics
NPI:1104606722
Name:PRESENQUI, AXEL (PT)
Entity type:Individual
Prefix:
First Name:AXEL
Middle Name:
Last Name:PRESENQUI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38435 5TH ST W APT J163
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-4549
Mailing Address - Country:US
Mailing Address - Phone:714-615-3787
Mailing Address - Fax:
Practice Address - Street 1:3167 RANCHO VISTA BLVD STE D
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-5517
Practice Address - Country:US
Practice Address - Phone:661-266-9578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-02
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA304928225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist