Provider Demographics
NPI:1598499980
Name:AUSTIN, ANSLEY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ANSLEY
Middle Name:
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 1:2089 TERON TRCE STE 120
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-1609
Mailing Address - Country:US
Mailing Address - Phone:770-904-6009
Mailing Address - Fax:
Practice Address - Street 1:1100 SHERWOOD PARK DR NE STE 220
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3426
Practice Address - Country:US
Practice Address - Phone:678-971-5048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT015972225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist