Provider Demographics
NPI:1003309758
Name:AUSTRIA, JANICE
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:AUSTRIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 NEW PINE LN
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:28328-4853
Mailing Address - Country:US
Mailing Address - Phone:910-337-5199
Mailing Address - Fax:
Practice Address - Street 1:120 SOUTHWOOD DR
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-5002
Practice Address - Country:US
Practice Address - Phone:910-299-3681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-07
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12604225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist