Healthcare Provider Details

I. General information

NPI: 1144787300
Provider Name (Legal Business Name): BRIAN ALEXANDER AUSTIN-YOUNG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2019
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18161 W 13 MILE RD STE A1
SOUTHFIELD MI
48076-1113
US

IV. Provider business mailing address

33900 HARPER AVE STE 104
CLINTON TWP MI
48035-4258
US

V. Phone/Fax

Practice location:
  • Phone: 248-633-2640
  • Fax: 248-633-2643
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5502009107
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: