Provider Demographics
NPI:1174826218
Name:AUSTRIA, PERRY DIMALANTA (PT)
Entity Type:Individual
Prefix:MR
First Name:PERRY
Middle Name:DIMALANTA
Last Name:AUSTRIA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 GARLAND ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-7129
Mailing Address - Country:US
Mailing Address - Phone:901-722-5508
Mailing Address - Fax:
Practice Address - Street 1:340 GARLAND ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-7129
Practice Address - Country:US
Practice Address - Phone:901-722-5508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000002487225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist