Healthcare Provider Details

I. General information

NPI: 1053560664
Provider Name (Legal Business Name): MARY K AUSTIN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2008
Last Update Date: 12/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 RIVERFRONT DR
LITTLE ROCK AR
72202
US

IV. Provider business mailing address

304 N PALM ST
LITTLE ROCK AR
72205-3831
US

V. Phone/Fax

Practice location:
  • Phone: 501-663-6965
  • Fax: 501-603-0675
Mailing address:
  • Phone: 501-664-3199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number814
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: