MEDICARE: AUSTIN BNPT INVESTMENT LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1356154827
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUSTIN BNPT INVESTMENT LLC

Provider Business Mailing Address
First Line	:	940 S KIMBALL AVE STE 175
Second Line	:
City	:	SOUTHLAKE
State	:	TX
Zip	:	76092-9024
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4425 S MOPAC EXPY BLDG 2
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78735-6723
Country	:	US
Telephone Number	:	817-421-0034
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	JULIE RADLEY
Credential	:
Telephone Number	:	713-591-2256

Provider Enumeration Date	:	01/29/2025
Last Update Date	:	01/29/2025

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