Healthcare Provider Details

I. General information

NPI: 1316405889
Provider Name (Legal Business Name): AUSTIN HUTCHINS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2019
Last Update Date: 03/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 RAILROAD ST
ELIZABETHTON TN
37643-2504
US

IV. Provider business mailing address

420 RAILROAD ST
ELIZABETHTON TN
37643-2504
US

V. Phone/Fax

Practice location:
  • Phone: 423-297-1813
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number12186
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: