Provider Demographics
NPI:1902006158
Name:AXIOM PHYSICAL THERAPY & REHABILITATION CENTER INC
Entity Type:Organization
Organization Name:AXIOM PHYSICAL THERAPY & REHABILITATION CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:ASIF
Authorized Official - Middle Name:MAJEED
Authorized Official - Last Name:CHAUDHRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-329-3977
Mailing Address - Street 1:18254 LIVERNOIS AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-4214
Mailing Address - Country:US
Mailing Address - Phone:313-329-3977
Mailing Address - Fax:
Practice Address - Street 1:18254 LIVERNOIS AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48221-4214
Practice Address - Country:US
Practice Address - Phone:313-329-3977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI23-6820OtherOUT PATIENT REHABILITATIO
MI236820Medicare Oscar/Certification