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NPI Code Detail

MEDICARE: AUSTEN L STUTSMAN DPT, NREMT

MEDICARE: AUSTEN L STUTSMAN DPT, NREMT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist6743SC
2225100000XPhysical TherapistWA

General Provider Information

NPI Number : 1376899054
Entity Type Code : Individual
Provider Name (Legal Business Name) : AUSTEN L STUTSMAN DPT, NREMT
Provider Business Mailing Address
First Line : 790 REMINGTON BLVD
Second Line :
City : BOLINGBROOK
State : IL
Zip : 60440-4909
Country : US
Telephone Number : 630-296-2223
Fax Number :
Provider Business Practice Location Address
First Line : 405 NW GILMAN BLVD
Second Line : SUITE 200
City : ISSAQUAH
State : WA
Zip : 98027-2470
Country : US
Telephone Number : 425-392-6804
Fax Number : 425-392-6805
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/31/2012
Last Update Date : 07/09/2015

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