Provider Demographics
NPI:1356763940
Name:AXIOM PT& OT PLUS,PLLC
Entity type:Organization
Organization Name:AXIOM PT& OT PLUS,PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:914-961-1010
Mailing Address - Street 1:115 MAIN ST
Mailing Address - Street 2:SUITE 202 2ND FLOOR
Mailing Address - City:TUCKAHOE
Mailing Address - State:NY
Mailing Address - Zip Code:10707-2948
Mailing Address - Country:US
Mailing Address - Phone:914-961-1010
Mailing Address - Fax:914-961-1011
Practice Address - Street 1:625 MCLEAN AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10705-4735
Practice Address - Country:US
Practice Address - Phone:914-961-1010
Practice Address - Fax:914-961-1011
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AXIOM PT AND OT PLUS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-01-15
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03282455Medicaid
NYA100031645Medicare PIN