Provider Demographics
NPI:1205864816
Name:AXIS PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:AXIS PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:WALDRON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:425-672-2910
Mailing Address - Street 1:21009 76TH AVE W
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7126
Mailing Address - Country:US
Mailing Address - Phone:425-672-2910
Mailing Address - Fax:425-778-1872
Practice Address - Street 1:21009 76TH AVE W
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7126
Practice Address - Country:US
Practice Address - Phone:425-672-2910
Practice Address - Fax:425-778-1872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602 606 543 1 1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty