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General NPI Number Information
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NPI Number | 1750930897
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Entity Type | Individual
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Provider Name | DANIELLE ALEXANDRIA AUSTIN PTA
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Gender | Female
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Dates
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Enumeration Date | 09/11/2019
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Last Update Date | 09/11/2019
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Provider Practice Location Address
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Address Line | 15425 MANCHESTER RD
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City | BALLWIN
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State | MO
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Zip | 63011-3077
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Country | US
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Telephone | 636-220-6969
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Fax | 636-220-6973
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Provider Business Mailing Address
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Address Line | 352 MASON RIDGE DR
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City | SAINT CHARLES
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State | MO
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Zip | 63304-7284
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Country | US
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Telephone | 636-288-6100
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2019034111
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License Number State | MO
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