Provider Demographics
NPI:1700251956
Name:AXIS THERAPY SERVICES
Entity type:Organization
Organization Name:AXIS THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:CUNNINGHAM
Authorized Official - Last Name:KLEMM
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MPH
Authorized Official - Phone:979-450-6734
Mailing Address - Street 1:1721 BIRMINGHAM DR
Mailing Address - Street 2:200
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-4082
Mailing Address - Country:US
Mailing Address - Phone:979-704-6482
Mailing Address - Fax:979-704-6483
Practice Address - Street 1:1721 BIRMINGHAM DR
Practice Address - Street 2:SUITE 200
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-4082
Practice Address - Country:US
Practice Address - Phone:979-704-6482
Practice Address - Fax:979-704-6483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-14
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1219421261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy