Provider Demographics
NPI:1598316028
Name:AUSTIN, GREGORY (DPT)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:
Last Name:AUSTIN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 NEWBURG RD APT 2
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-1459
Mailing Address - Country:US
Mailing Address - Phone:270-562-2812
Mailing Address - Fax:
Practice Address - Street 1:210 E GRAY ST STE 807
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3927
Practice Address - Country:US
Practice Address - Phone:502-587-9350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-25
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY007813225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist