Provider Demographics
NPI:1588032692
Name:AXELROD, JARETT
Entity Type:Individual
Prefix:
First Name:JARETT
Middle Name:
Last Name:AXELROD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7625 E CAMELBACK RD
Mailing Address - Street 2:#222A
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-2105
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2853 S SOSSAMAN RD
Practice Address - Street 2:A106
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-9625
Practice Address - Country:US
Practice Address - Phone:480-373-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-04
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11762225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist