Provider Demographics
NPI:1578832911
Name:AUSTIN, JAMES RYLAND (PT,DPT,MTC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:RYLAND
Last Name:AUSTIN
Suffix:
Gender:M
Credentials:PT,DPT,MTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 W TOWN PL STE 5
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-3102
Mailing Address - Country:US
Mailing Address - Phone:904-342-5262
Mailing Address - Fax:
Practice Address - Street 1:319 W TOWN PL STE 5
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-3102
Practice Address - Country:US
Practice Address - Phone:904-342-5262
Practice Address - Fax:904-217-3580
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-14
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT27076225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist