Healthcare Provider Details

I. General information

NPI: 1790713873
Provider Name (Legal Business Name): MARY JOHNSTON AUSTIN PHYSICAL THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. MARY J. AUSTIN

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 ROCKLAND RD
ROSCOE NY
12776-5307
US

IV. Provider business mailing address

9 ROCKLAND RD
ROSCOE NY
12776-5307
US

V. Phone/Fax

Practice location:
  • Phone: 607-498-5653
  • Fax:
Mailing address:
  • Phone: 607-498-5653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number0050371
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: