Healthcare Provider Details

I. General information

NPI: 1487454773
Provider Name (Legal Business Name): AUSTIN LEE ROBERTS DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2025
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 RACQUET LN
YAKIMA WA
98902-6114
US

IV. Provider business mailing address

2505 RACQUET LN
YAKIMA WA
98902-6114
US

V. Phone/Fax

Practice location:
  • Phone: 509-453-7325
  • Fax:
Mailing address:
  • Phone: 509-453-7325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number1322254
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT70047573
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: