Provider Demographics
NPI:1881802486
Name:AXIS MASSAGE CENTRE, INC.
Entity type:Organization
Organization Name:AXIS MASSAGE CENTRE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED MASSAGE THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:CMT
Authorized Official - Phone:570-368-7580
Mailing Address - Street 1:1712 CLARION DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-1929
Mailing Address - Country:US
Mailing Address - Phone:570-368-7580
Mailing Address - Fax:570-329-3296
Practice Address - Street 1:1712 CLARION DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-1929
Practice Address - Country:US
Practice Address - Phone:570-368-7580
Practice Address - Fax:570-329-3296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty