Provider Demographics
NPI:1093284945
Name:AUSTIN, NATHAN LEE (DPT)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:LEE
Last Name:AUSTIN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 W DRAKE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-2880
Mailing Address - Country:US
Mailing Address - Phone:970-204-9635
Mailing Address - Fax:970-204-9730
Practice Address - Street 1:343 W DRAKE RD STE 102
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-2880
Practice Address - Country:US
Practice Address - Phone:970-204-9635
Practice Address - Fax:970-204-9730
Is Sole Proprietor?:No
Enumeration Date:2018-11-21
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0016050225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist