Provider Demographics
NPI:1578900072
Name:AUSTIN, KEILY LYNN (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:KEILY
Middle Name:LYNN
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 HYACINTH LN
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-3954
Mailing Address - Country:US
Mailing Address - Phone:770-823-4029
Mailing Address - Fax:
Practice Address - Street 1:822 HYACINTH LN
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-3954
Practice Address - Country:US
Practice Address - Phone:770-823-4029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-24
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT010998225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist