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General NPI Number Information
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NPI Number | 1679948483
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Entity Type | Organization
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Legal Business Name | AUSTIN SPORTS THERAPY
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Dates
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Enumeration Date | 12/04/2015
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Last Update Date | 12/04/2015
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Provider Practice Location Address
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Address Line | 3303 NORTHLAND DR. #210
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City | AUSTIN
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State | TX
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Zip | 78759
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Country | US
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Telephone | 512-407-8292
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Fax |
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Provider Business Mailing Address
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Address Line | 8529 N CAPITAL OF TX HWY APT. 3060
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City | AUSTIN
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State | TX
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Zip | 78759
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | JUNIOR ASSOCIATE
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Name | DONALD LEVIN
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Credential | D.C.
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Telephone | 508-523-0005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 13027
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License Number State | TX
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