Provider Demographics
NPI:1902841794
Name:PROAXIS SPARTANBURG, LLC
Entity Type:Organization
Organization Name:PROAXIS SPARTANBURG, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:ROBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEONARD
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:864-528-5707
Mailing Address - Street 1:125 THE PKWY
Mailing Address - Street 2:SUITE 501
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-6610
Mailing Address - Country:US
Mailing Address - Phone:864-528-5700
Mailing Address - Fax:864-528-5701
Practice Address - Street 1:333 S PINE ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-2622
Practice Address - Country:US
Practice Address - Phone:864-515-7580
Practice Address - Fax:864-515-7580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC8170Medicare ID - Type UnspecifiedGROUP