Provider Demographics
NPI:1417041518
Name:SOUTH AUSTIN THERAPY GROUP, INC
Entity Type:Organization
Organization Name:SOUTH AUSTIN THERAPY GROUP, INC
Other - Org Name:SOUTH AUSTIN THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ELIAS
Authorized Official - Middle Name:
Authorized Official - Last Name:GALVAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:512-892-5250
Mailing Address - Street 1:1825 FORTVIEW RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-7657
Mailing Address - Country:US
Mailing Address - Phone:512-892-5250
Mailing Address - Fax:512-892-7183
Practice Address - Street 1:1825 FORTVIEW RD
Practice Address - Street 2:STE 109
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-7657
Practice Address - Country:US
Practice Address - Phone:512-892-5250
Practice Address - Fax:512-892-7183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1013902261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy