MEDICARE: AUSTIN MACIAS DPT

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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1376264259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUSTIN MACIAS DPT

Provider Business Mailing Address
First Line	:	1773 STAR BATT DR
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48309-3708
Country	:	US
Telephone Number	:	248-601-9207
Fax Number	:

Provider Business Practice Location Address
First Line	:	31645 SOUTHFIELD RD
Second Line	:
City	:	BEVERLY HILLS
State	:	MI
Zip	:	48025-5443
Country	:	US
Telephone Number	:	248-564-3535
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2022
Last Update Date	:	09/08/2022

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