=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215711882
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DARRYN ATKINSON PT, MPT, PHD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/23/2023
-----------------------------------------------------
Last Update Date | 08/23/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1719 TIMBER RIDGE DR
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78741-5542
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-348-6544
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1719 TIMBER RIDGE DR
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78741-5542
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-348-6544
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 1162793
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------