Healthcare Provider Details

I. General information

NPI: 1649320250
Provider Name (Legal Business Name): NICHOLAS A AUSTIN MSPT, OCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 03/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 PARKER DR SUITE B
LAGRANGE KY
40031-1200
US

IV. Provider business mailing address

13415 FOREST SPRINGS DR
LOUISVILLE KY
40245-2077
US

V. Phone/Fax

Practice location:
  • Phone: 502-222-0280
  • Fax: 502-222-0290
Mailing address:
  • Phone: 502-742-4825
  • Fax: 502-222-0290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number004132
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number004132
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: