Healthcare Provider Details

I. General information

NPI: 1619306636
Provider Name (Legal Business Name): AUSTIN PRATT ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2013
Last Update Date: 11/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6314 HOUGH RD
CONESUS NY
14435-9616
US

IV. Provider business mailing address

4577 MORGAN VIEW RD
GENESEO NY
14454-9428
US

V. Phone/Fax

Practice location:
  • Phone: 585-478-6500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number002584-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: