Provider Demographics
NPI:1316966344
Name:AXIS PHYSICAL THERAPY
Entity type:Organization
Organization Name:AXIS PHYSICAL THERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/P.T.
Authorized Official - Prefix:MR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:TEERING
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:831-757-3055
Mailing Address - Street 1:505 E ROMIE LN
Mailing Address - Street 2:SUITE#I
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-4031
Mailing Address - Country:US
Mailing Address - Phone:831-757-3055
Mailing Address - Fax:831-757-5622
Practice Address - Street 1:505 E ROMIE LN
Practice Address - Street 2:SUITE#I
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-4031
Practice Address - Country:US
Practice Address - Phone:831-757-3055
Practice Address - Fax:831-757-5622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT16753225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ26997ZOtherBLUE CROSS
CAZZZ26996ZOtherBLUE CROSS
CA0PT16753Medicare ID - Type UnspecifiedPHYSICAL THERAPY
CA0PT17531Medicare ID - Type UnspecifiedPHYSICAL THERAPY
CA0PT38211Medicare PIN