Provider Demographics
NPI:1952652984
Name:AXIS SPORTS MEDICINE, LLC
Entity Type:Organization
Organization Name:AXIS SPORTS MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-728-6531
Mailing Address - Street 1:PO BOX 5584
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:CO
Mailing Address - Zip Code:80443-5584
Mailing Address - Country:US
Mailing Address - Phone:970-790-9600
Mailing Address - Fax:
Practice Address - Street 1:142 E BEAVER CREEK PLACE
Practice Address - Street 2:UNIT 109 ANNEX BLD
Practice Address - City:AVON
Practice Address - State:CO
Practice Address - Zip Code:81620
Practice Address - Country:US
Practice Address - Phone:970-790-9600
Practice Address - Fax:970-790-9601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-01
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty