Provider Demographics
NPI:1467881144
Name:AUSTRIA, MA ELENA
Entity Type:Individual
Prefix:
First Name:MA ELENA
Middle Name:
Last Name:AUSTRIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19933 MARDI GRAS ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32833-3713
Mailing Address - Country:US
Mailing Address - Phone:407-568-6135
Mailing Address - Fax:
Practice Address - Street 1:19933 MARDI GRAS ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32833-3713
Practice Address - Country:US
Practice Address - Phone:407-568-6135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT8795225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist