MEDICARE: AUSTIN R WIDICK 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	32088	AZ

General Provider Information

NPI Number	:	1609534205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUSTIN R WIDICK DPT

Provider Business Mailing Address
First Line	:	15410 S MOUNTAIN PKWY STE 112
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85044-6691
Country	:	US
Telephone Number	:	480-706-1161
Fax Number	:

Provider Business Practice Location Address
First Line	:	13967 W GRAND AVE STE 100
Second Line	:
City	:	SURPRISE
State	:	AZ
Zip	:	85374-3732
Country	:	US
Telephone Number	:	623-474-3952
Fax Number	:	623-474-3953

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

Provider Enumeration Date	:	12/01/2021
Last Update Date	:	12/13/2021

Similar Medicare Providers

1780900894 — DOUGLAS SCOTT ZAVOS AU.D.
Practice Location Address:

13967 W GRAND AVE , #105
SURPRISE, AZ
85374-3732

Practice Phone: 623-266-3003
Practice Fax: 623-572-0237

1972821932 — ZAVOS HEARING AIDS AND AUDIOLOGY, LLC
Practice Location Address:

13967 W GRAND AVE , #105
SURPRISE, AZ
85374-3732

Practice Phone: 623-266-3003
Practice Fax: 623-251-6387

1639624075 — MAX MANGABAT DPT
Practice Location Address:

13967 W GRAND AVE , SUITE C-100
SURPRISE, AZ
85374-3732

Practice Phone: 623-474-3952
Practice Fax: 623-474-3953

1942719547 — JOSHUA NIESEN PT
Practice Location Address:

13967 W GRAND AVE # C-100
SURPRISE, AZ
85374-3732

Practice Phone: 623-474-3952
Practice Fax:

1750873287 — THE PAIN CENTER OF ARIZONA, PC
Practice Location Address:

13967 W GRAND AVE STE 103
SURPRISE, AZ
85374-3732

Practice Phone: 623-516-8252
Practice Fax: 623-516-8253

1578109583 — LUIS FERNANDO LOBO PT, DPT
Practice Location Address:

13967 W GRAND AVE STE C-100
SURPRISE, AZ
85374-3732

Practice Phone: 623-474-3952
Practice Fax: 623-474-3953

Directions to “ AUSTIN R WIDICK DPT” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.