Provider Demographics
NPI:1225193873
Name:AUSTIN, PAULA MATTHEWS (PT)
Entity Type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:MATTHEWS
Last Name:AUSTIN
Suffix:
Gender:F
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:PO BOX 106
Mailing Address - Street 2:2542 ROUTE 105
Mailing Address - City:NEWPORT CENTER
Mailing Address - State:VT
Mailing Address - Zip Code:05857
Mailing Address - Country:US
Mailing Address - Phone:802-334-8882
Mailing Address - Fax:802-334-8868
Practice Address - Street 1:2542 ROUTE 105
Practice Address - Street 2:
Practice Address - City:NEWPORT CENTER
Practice Address - State:VT
Practice Address - Zip Code:05857
Practice Address - Country:US
Practice Address - Phone:802-334-8882
Practice Address - Fax:802-334-8868
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0400002235225100000X
VT0400002630225100000X
VT0410000278225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1011239Medicaid
VT1011239Medicaid