Healthcare Provider Details

I. General information

NPI: 1437649829
Provider Name (Legal Business Name): AUSTIN KROUT LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2018
Last Update Date: 05/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 FURNACE HILLS PIKE
LITITZ PA
17543-8907
US

IV. Provider business mailing address

690 FURNACE HILLS PIKE
LITITZ PA
17543-8907
US

V. Phone/Fax

Practice location:
  • Phone: 717-626-6288
  • Fax:
Mailing address:
  • Phone: 717-626-6288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMSG012025
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier81-3753875
Identifier TypeOTHER
Identifier State
Identifier IssuerMASSAGE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: