Provider Demographics
NPI:1598315699
Name:HARDIN, AUTUMN (DPT)
Entity Type:Individual
Prefix:DR
First Name:AUTUMN
Middle Name:
Last Name:HARDIN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4027 DOWLEN RD
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-6850
Mailing Address - Country:US
Mailing Address - Phone:409-899-2765
Mailing Address - Fax:409-924-9468
Practice Address - Street 1:4027 DOWLEN RD
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-6850
Practice Address - Country:US
Practice Address - Phone:409-899-2765
Practice Address - Fax:409-924-9468
Is Sole Proprietor?:No
Enumeration Date:2019-09-19
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13183792251N0400X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology