MEDICARE: SOUTH AUSTIN THERAPY GROUP, INC

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	1013902	TX

General Provider Information

NPI Number	:	1417041518
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH AUSTIN THERAPY GROUP, INC

Provider Business Mailing Address
First Line	:	1825 FORTVIEW RD
Second Line	:	SUITE 109
City	:	AUSTIN
State	:	TX
Zip	:	78704-7657
Country	:	US
Telephone Number	:	512-892-5250
Fax Number	:	512-892-7183

Provider Business Practice Location Address
First Line	:	1825 FORTVIEW RD
Second Line	:	STE 109
City	:	AUSTIN
State	:	TX
Zip	:	78704-7657
Country	:	US
Telephone Number	:	512-892-5250
Fax Number	:	512-892-7183

Authorized Official
Title or Position	:	PRESIDENT, PHYSICAL THERAPIST
Name	:	MR. ELIAS GALVAN
Credential	:	PHYSICAL THERAPIST
Telephone Number	:	512-892-5250

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	06/29/2015

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