Healthcare Provider Details

I. General information

NPI: 1518612001
Provider Name (Legal Business Name): ROBERT B AUSTIN JR. LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2022
Last Update Date: 02/14/2022
Certification Date: 02/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 SPICEWOOD RD
NORWALK CT
06854-2544
US

IV. Provider business mailing address

14 SPICEWOOD RD
NORWALK CT
06854-2544
US

V. Phone/Fax

Practice location:
  • Phone: 203-831-8366
  • Fax:
Mailing address:
  • Phone: 203-831-8366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number012985
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number002118
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: