Provider Demographics
NPI:1598775561
Name:AUSTIN, EDWARD FRANK JR (PHYSICAL THARAPIST)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:FRANK
Last Name:AUSTIN
Suffix:JR
Gender:M
Credentials:PHYSICAL THARAPIST
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Mailing Address - Street 1:PO BOX 392
Mailing Address - Street 2:
Mailing Address - City:WATSON
Mailing Address - State:LA
Mailing Address - Zip Code:70786
Mailing Address - Country:US
Mailing Address - Phone:225-275-9293
Mailing Address - Fax:225-275-7671
Practice Address - Street 1:12180 GREENWELL SPRINGS ROAD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70814
Practice Address - Country:US
Practice Address - Phone:225-275-9293
Practice Address - Fax:225-275-7671
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA06523225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
4H024Medicare ID - Type Unspecified
5C580Medicare ID - Type Unspecified