Provider Demographics
NPI:1457486623
Name:THERA-PAX ENTERPRISES, INC.
Entity Type:Organization
Organization Name:THERA-PAX ENTERPRISES, INC.
Other - Org Name:PAXTON PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:PAXTON
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:318-324-1592
Mailing Address - Street 1:1123 FORSYTHE AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-4307
Mailing Address - Country:US
Mailing Address - Phone:318-324-1592
Mailing Address - Fax:318-324-1593
Practice Address - Street 1:1123 FORSYTHE AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-4307
Practice Address - Country:US
Practice Address - Phone:318-324-1592
Practice Address - Fax:318-324-1593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA06735R225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty