Provider Demographics
NPI:1376689174
Name:AUSTIN, NATHAN JAY (PT)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:JAY
Last Name:AUSTIN
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 1:201 GOVERNORS DRIVE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-5123
Mailing Address - Country:US
Mailing Address - Phone:256-533-1600
Mailing Address - Fax:256-539-0856
Practice Address - Street 1:201 GOVERNORS DRIVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5123
Practice Address - Country:US
Practice Address - Phone:256-533-1600
Practice Address - Fax:256-539-0856
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH3335225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051504929Medicaid
ALQ56460Medicare UPIN
AL051504929Medicaid