Healthcare Provider Details

I. General information

NPI: 1750836607
Provider Name (Legal Business Name): AUSTEN HUTTON DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2016
Last Update Date: 08/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2308 SOUTHEAST BLVD
SALEM OH
44460-3418
US

IV. Provider business mailing address

2308 SOUTHEAST BLVD
SALEM OH
44460-3418
US

V. Phone/Fax

Practice location:
  • Phone: 330-332-8488
  • Fax: 330-332-4441
Mailing address:
  • Phone: 330-332-8488
  • Fax: 330-332-4441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT016523
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: