Provider Demographics
NPI:1205403110
Name:FELMAN, AUSTIN WADE (DPT)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:WADE
Last Name:FELMAN
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 1:1613 N 500 W
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84014-3048
Mailing Address - Country:US
Mailing Address - Phone:801-897-6223
Mailing Address - Fax:
Practice Address - Street 1:1613 N 500 W
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:UT
Practice Address - Zip Code:84014-3048
Practice Address - Country:US
Practice Address - Phone:801-897-6223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-09
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12296171-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist