NPIMap

Organization Active NPI

Axis Physiotherapy Institute, LLC

  • Physical Therapist
  • Fort Walton Beach, FL
National Provider Identifier
1790328045
Registry record updated Oct 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
AXIS PHYSIOTHERAPY INSTITUTE, LLC
Practice address
339 Racetrack Rd NW Ste 18&20
Fort Walton Beach, FL 32547-1538
Phone
(850) 499-9033
NPI assigned
Oct 18, 2019
Last updated
Oct 23, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Matthew Leary, DPT, ATCNPI 1144571852
Title
Co-Owner/ Physical Therapist
Phone
(850) 499-9033

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

339 Racetrack Rd NW Ste 18&20
Fort Walton Beach, FL 32547-1538

Mailing address

1646 Parkside Cir
Niceville, FL 32578-8706
Phone (850) 499-9033

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191216000594 FL Part B Supplier - Physical/Occupational Therapy Group in Private Practice 2860825353 Receives reassigned benefits from 16 practitioners
Practice locations: Destin, FL; Fort Walton Beach, FL; Freeport, FL

National Provider Directory

National Provider Directory
Tax ID family
Axis Physiotherapy Institute2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

34894 Emerald Coast Pkwy
Unit 3
Destin, FL 32541

34896 Emerald Coast Pkwy
Ste 3
Destin, FL 32541
Phone (850) 374-8158

339 Racetrack Rd NW
Ste 1820
Fort Walton Beach, FL 32547
Phone (850) 499-9033

339 Racetrack Rd NW
Ste 20
Ft Walton Bch, FL 32547
Phone (850) 374-8158

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 16

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1571356800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1571788800000",
    "number": "1790328045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1646 PARKSIDE CIR",
            "city": "NICEVILLE",
            "state": "FL",
            "postal_code": "325788706",
            "telephone_number": "850-499-9033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "339 RACETRACK RD NW STE 18&20",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325471538",
            "telephone_number": "850-499-9033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AXIS PHYSIOTHERAPY INSTITUTE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-18",
        "last_updated": "2019-10-23",
        "status": "A",
        "authorized_official_last_name": "LEARY",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "CO-OWNER/ PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "850-499-9033",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPT, ATC"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Walton Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.