Provider Demographics
NPI:1619306636
Name:PRATT, AUSTIN (ATC)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:
Last Name:PRATT
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4577 MORGAN VIEW RD
Mailing Address - Street 2:
Mailing Address - City:GENESEO
Mailing Address - State:NY
Mailing Address - Zip Code:14454-9428
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6314 HOUGH RD
Practice Address - Street 2:
Practice Address - City:CONESUS
Practice Address - State:NY
Practice Address - Zip Code:14435-9616
Practice Address - Country:US
Practice Address - Phone:585-478-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-12
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002584-12255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer