Provider Demographics
NPI:1558737684
Name:AUSTIN PHYSICAL THERAPY
Entity Type:Organization
Organization Name:AUSTIN PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELTON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:256-776-4547
Mailing Address - Street 1:2089 CECIL ASHBURN DR SE
Mailing Address - Street 2:STE 202
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-2567
Mailing Address - Country:US
Mailing Address - Phone:256-883-9494
Mailing Address - Fax:
Practice Address - Street 1:2089 CECIL ASHBURN DR SE
Practice Address - Street 2:STE 202
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-2567
Practice Address - Country:US
Practice Address - Phone:256-883-9494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH2921261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy