Leslie Allison Axford, PT, DPT

Key facts

NPI

1578076576

Entity type

Individual (NPI type 1)

Primary specialty

Physical Therapist 225100000X

License

23014 (MA)

Practice address

1493 Cambridge St
Cambridge, MA 02139-1047

Phone

(617) 665-1579

NPI assigned

Nov 13, 2017

Sex

Female

Sole proprietor

Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Carolina Physical Therapy and Sports Medicine, Inc. Physical Medicine & Rehabilitation Physician · Columbia, SC · NPI 1952491490
  NPD

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

Yes

State licenses

Practice roles

Locations

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Nov 13, 2017.

{
    "created_epoch": "1510531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1510531200000",
    "number": "1578076576",
    "addresses": [
        {
            "country_code": "CA",
            "country_name": "Canada",
            "address_purpose": "MAILING",
            "address_type": "FGN",
            "address_1": "40 SWANTONDRIVE",
            "city": "DARTMOUTH",
            "state": "NOVA SCOTIA",
            "postal_code": "B2W 2C5"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1493 CAMBRIDGE ST",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "021391047",
            "telephone_number": "617-665-1579"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AXFORD",
        "first_name": "LESLIE",
        "middle_name": "ALLISON",
        "credential": "PT, DPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-11-13",
        "last_updated": "2017-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MA",
            "license": "23014",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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