MEDICARE: MR. EDWARD FRANK AUSTIN JR. PHYSICAL THARAPIST

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
1	225100000X	Physical Therapist	06523	LA

General Provider Information

NPI Number	:	1598775561
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EDWARD FRANK AUSTIN JR. PHYSICAL THARAPIST

Provider Business Mailing Address
First Line	:	PO BOX 392
Second Line	:
City	:	WATSON
State	:	LA
Zip	:	70786
Country	:	US
Telephone Number	:	225-275-9293
Fax Number	:	225-275-7671

Provider Business Practice Location Address
First Line	:	12180 GREENWELL SPRINGS ROAD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70814
Country	:	US
Telephone Number	:	225-275-9293
Fax Number	:	225-275-7671

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	07/08/2007

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