# AXIS BRAIN AND BACK INSTITUTE PLLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** AXIS BRAIN AND BACK INSTITUTE PLLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1295641736
- **Legal business name:** AXIS BRAIN AND BACK INSTITUTE PLLC
- **Authorized official:** MS. AMBER MARIE MARTY (PRACTICE ADMINISTRATOR)
- **Authorized official phone:** (817) 502-7411

## Contact information

- **Practice address:** 1110 E STATE HIGHWAY 114 STE 100, SOUTHLAKE, TX 76092-5251
- **Practice address phone:** (817) 502-7411
- **Practice address fax:** (817) 502-7412
- **Mailing address:** 1110 E STATE HIGHWAY 114 STE 100, SOUTHLAKE, TX 76092-5251
- **Mailing address phone:** (817) 502-7411
- **Mailing address fax:** (817) 502-7412

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | Yes |

## Other

- **Enumeration date:** 08/24/2026
- **Last updated:** 08/25/2026