Provider Demographics
NPI:1205202470
Name:AXON PHYSICAL THERAPY CLINIC, LLC
Entity Type:Organization
Organization Name:AXON PHYSICAL THERAPY CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPY
Authorized Official - Prefix:
Authorized Official - First Name:KALKIDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GETAHUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-399-1376
Mailing Address - Street 1:85 S BRAGG ST
Mailing Address - Street 2:SUITE 504
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-2797
Mailing Address - Country:US
Mailing Address - Phone:703-399-1376
Mailing Address - Fax:
Practice Address - Street 1:85 S BRAGG ST
Practice Address - Street 2:SUITE 504
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312-2797
Practice Address - Country:US
Practice Address - Phone:703-399-1376
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-11
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty