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AXIOM REHABILITATION LLC



Provider NPI: 1912456799

Organization Information:
Organization Name:  AXIOM REHABILITATION LLC
Organization is not Subpart
Authorized Official:  DUSTIN PATRIC MOURA  REGISTERED AGENT  407-388-8866

Practice Location:
498 PALM SPRINGS DR STE 345  ALTAMONTE SPRINGS, FL 32701-7806 US
Tel: 407-494-0644  Fax: 407-494-0644

Business Mailing Address:
498 PALM SPRINGS DR. STE 345 ALTAMONTE SPRINGS, FL 32701-3468 US
Tel: (40-7) -494-0644  Fax: 407-494-0644

NPI Information:
NPI: 1912456799
Entity Type: Organization

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
N103K00000X

N2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service Providers
Physical Therapist
N225200000XRespiratory, Developmental, Rehabilitative and Restorative Service Providers
Physical Therapy Assistant
N225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service Providers
Occupational Therapist
N225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service Providers
Occupational Therapist
FL
N235Z00000XSpeech, Language and Hearing Service Providers
Speech-Language Pathologist
N252Y00000XAgencies
Early Intervention Provider Agency
N225100000XRespiratory, Developmental, Rehabilitative and Restorative Service Providers
Physical Therapist
N2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service Providers
Physical Therapist
N224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service Providers
Occupational Therapy Assistant
Y261QR0400XAmbulatory Health Care Facilities
Clinic/Center

Other Provider Identifiers:

IssuerNumberStateType
UNITED HEALTHCARE (OPTUM)045208FL01
019968100FL05



American Medical Association 2012 taxonomy code information

Code: 261QR0400X

Type:

Classification:



Definition:



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