Healthcare Provider Details

I. General information

NPI: 1912964594
Provider Name (Legal Business Name): TRICIA M. AUSTIN PHD, PT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3518 LACLEDE AVE
SAINT LOUIS MO
63103-2011
US

IV. Provider business mailing address

901 WASHINGTON AVE # 205
SAINT LOUIS MO
63101-1203
US

V. Phone/Fax

Practice location:
  • Phone: 314-977-7419
  • Fax:
Mailing address:
  • Phone: 314-977-8554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2003019971
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: