Provider Demographics
NPI:1114306941
Name:ULRICH, AUSTIN
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:
Last Name:ULRICH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1777 W SAINT MARYS RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-2687
Mailing Address - Country:US
Mailing Address - Phone:520-884-9819
Mailing Address - Fax:520-884-0175
Practice Address - Street 1:7355 S HOUGHTON RD STE 109
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85747-9380
Practice Address - Country:US
Practice Address - Phone:520-664-9100
Practice Address - Fax:520-664-1099
Is Sole Proprietor?:No
Enumeration Date:2015-05-26
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0013279225100000X
AZLPT-31604225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist