Healthcare Provider Details

I. General information

NPI: 1639635394
Provider Name (Legal Business Name): OUTCOMES THERAPY OPS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2019
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13915 BURNET RD STE 103
AUSTIN TX
78728-6518
US

IV. Provider business mailing address

13915 BURNET RD STE 103
AUSTIN TX
78728-6518
US

V. Phone/Fax

Practice location:
  • Phone: 512-710-6516
  • Fax: 512-355-1966
Mailing address:
  • Phone: 512-710-6516
  • Fax: 512-355-1966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. CORY PETERSON
Title or Position: CEO
Credential: DPT
Phone: 512-710-6516