Provider Demographics
NPI:1558839209
Name:AXCEND PHYSICAL THERAPY
Entity Type:Organization
Organization Name:AXCEND PHYSICAL THERAPY
Other - Org Name:AXCEND PHYSICAL THERAPY
Other - Org Type:Other Name
Authorized Official - Title/Position:AUTHORIZED OFFICIAL / PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:UMESH
Authorized Official - Middle Name:C
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-239-5692
Mailing Address - Street 1:19015 TOWN CENTER DR STE 102
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92308-8995
Mailing Address - Country:US
Mailing Address - Phone:760-961-4240
Mailing Address - Fax:760-961-4705
Practice Address - Street 1:19015 TOWN CENTER DR STE 102
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92308-8995
Practice Address - Country:US
Practice Address - Phone:760-961-4240
Practice Address - Fax:760-961-4705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-09
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty