Provider Demographics
NPI:1871179119
Name:AXELBAUM, MIRIAM Z (DPT)
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:Z
Last Name:AXELBAUM
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:285 HYDRAULIC RIDGE ROAD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-8126
Mailing Address - Country:US
Mailing Address - Phone:434-817-0980
Mailing Address - Fax:434-817-0985
Practice Address - Street 1:285 HYDRAULIC RIDGE ROAD
Practice Address - Street 2:SUITE 4
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-8126
Practice Address - Country:US
Practice Address - Phone:434-817-0980
Practice Address - Fax:434-817-0985
Is Sole Proprietor?:No
Enumeration Date:2021-03-18
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA2305214155225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist