Provider Demographics
NPI:1841606167
Name:AXTELL, APRIL
Entity Type:Individual
Prefix:
First Name:APRIL
Middle Name:
Last Name:AXTELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1351 FOWLER ST
Mailing Address - Street 2:STE 110
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-4714
Mailing Address - Country:US
Mailing Address - Phone:509-942-2574
Mailing Address - Fax:509-942-2575
Practice Address - Street 1:901 N CURTIS RD STE 204
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-1340
Practice Address - Country:US
Practice Address - Phone:208-637-3315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-08
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60441572225100000X
IDPT-3708225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID20006989Medicare PIN