Provider Demographics
NPI:1497400667
Name:AXION TRAINER INC
Entity Type:Organization
Organization Name:AXION TRAINER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ABBEY JO
Authorized Official - Middle Name:
Authorized Official - Last Name:SHULKIN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:786-368-0076
Mailing Address - Street 1:5501 NW 2ND AVE APT 209
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-3855
Mailing Address - Country:US
Mailing Address - Phone:786-368-0076
Mailing Address - Fax:
Practice Address - Street 1:7035 BERACASA WAY STE 104
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3454
Practice Address - Country:US
Practice Address - Phone:561-361-4888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center