MEDICARE: MR. NICHOLAS A AUSTIN MSPT, OCS

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	2251X0800X	Orthopedic Physical Therapist	004132	KY
2	225100000X	Physical Therapist	004132	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000484221	OTHER	KY	ANTHEM PROVIDER ID
2	000000946564	OTHER	KY	BLUE CROSS BLUE SHIELD
3	4132	OTHER	KY	KY STATE LICENSE
4	9514	OTHER	KY	OCS CERTIFICATION
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649320250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NICHOLAS A AUSTIN MSPT, OCS

Provider Business Mailing Address
First Line	:	13415 FOREST SPRINGS DR
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40245-2077
Country	:	US
Telephone Number	:	502-742-4825
Fax Number	:	502-222-0290

Provider Business Practice Location Address
First Line	:	214 PARKER DR
Second Line	:	SUITE B
City	:	LAGRANGE
State	:	KY
Zip	:	40031-1200
Country	:	US
Telephone Number	:	502-222-0280
Fax Number	:	502-222-0290

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

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	03/08/2017

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Directions to “ MR. NICHOLAS A AUSTIN MSPT, OCS” Practice Location

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