Provider Demographics
NPI:1962288068
Name:AXIS PT
Entity type:Organization
Organization Name:AXIS PT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MORGAN
Authorized Official - Middle Name:ARIEL
Authorized Official - Last Name:GLAZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-353-2225
Mailing Address - Street 1:24725 W 12 MILE RD STE 260
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-8310
Mailing Address - Country:US
Mailing Address - Phone:248-550-4800
Mailing Address - Fax:
Practice Address - Street 1:24725 W 12 MILE RD STE 260
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-8310
Practice Address - Country:US
Practice Address - Phone:248-550-4800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-05
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty