Healthcare Provider Details

I. General information

NPI: 1598775561
Provider Name (Legal Business Name): EDWARD FRANK AUSTIN JR. PHYSICAL THARAPIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12180 GREENWELL SPRINGS ROAD
BATON ROUGE LA
70814
US

IV. Provider business mailing address

PO BOX 392
WATSON LA
70786
US

V. Phone/Fax

Practice location:
  • Phone: 225-275-9293
  • Fax: 225-275-7671
Mailing address:
  • Phone: 225-275-9293
  • Fax: 225-275-7671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number06523
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: