Provider Demographics
NPI:1477809226
Name:ISHAM, AUSTIN ALAN (DPT)
Entity Type:Individual
Prefix:MR
First Name:AUSTIN
Middle Name:ALAN
Last Name:ISHAM
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 1:201 N 78TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66112
Mailing Address - Country:US
Mailing Address - Phone:913-226-9231
Mailing Address - Fax:
Practice Address - Street 1:2740 1ST AVE NE
Practice Address - Street 2:#1
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-4856
Practice Address - Country:US
Practice Address - Phone:319-398-6034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012025073225100000X
225100000X
KS11-04469225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist