Healthcare Provider Details

I. General information

NPI: 1396410627
Provider Name (Legal Business Name): AUSTIN STEWART MORRIS PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2021
Last Update Date: 08/10/2021
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 W SAGINAW ST
LANSING MI
48915-2033
US

IV. Provider business mailing address

1100 W SAGINAW ST
LANSING MI
48915-2033
US

V. Phone/Fax

Practice location:
  • Phone: 517-321-4646
  • Fax: 517-321-4825
Mailing address:
  • Phone: 517-321-4646
  • Fax: 517-321-4825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5502006465
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: