Provider Demographics
NPI:1851080972
Name:AXEL REHABILITATION SERVICES LLC
Entity Type:Organization
Organization Name:AXEL REHABILITATION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:JESSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:LLORENTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-208-6648
Mailing Address - Street 1:4820 GRIFFIN BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-2016
Mailing Address - Country:US
Mailing Address - Phone:239-208-6648
Mailing Address - Fax:855-462-3008
Practice Address - Street 1:4755 SUMMERLIN RD STE 8
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-1073
Practice Address - Country:US
Practice Address - Phone:239-208-6648
Practice Address - Fax:855-462-3008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Multi-Specialty