Provider Demographics
NPI:1518131234
Name:AUSTIN, CHRISHAWNTA DENISE (RPT)
Entity Type:Individual
Prefix:
First Name:CHRISHAWNTA
Middle Name:DENISE
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6659 SULLIVAN RD
Mailing Address - Street 2:
Mailing Address - City:GREENWELL SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70739-3112
Mailing Address - Country:US
Mailing Address - Phone:225-261-0160
Mailing Address - Fax:225-261-0898
Practice Address - Street 1:6659 SULLIVAN RD
Practice Address - Street 2:
Practice Address - City:GREENWELL SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70739-3112
Practice Address - Country:US
Practice Address - Phone:225-261-0160
Practice Address - Fax:225-261-0898
Is Sole Proprietor?:No
Enumeration Date:2008-04-14
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT23765225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT23765OtherSTATE
LA3C836DP57Medicare Oscar/Certification